Oral health of older people admitted to hospital for needs assessment.

OBJECTIVES: To describe the clinical oral health status, treatment needs and oral-health-related quality of life (OHRQoL) of older people admitted to older persons' wards at Dunedin Public Hospital due to a sudden worsening of their general health. Participants and methods: A systematic oral assessment was undertaken for a consecutive case series of 200 patients (59.5% female; mean age 82.6 years, sd 6.6) admitted to older person's wards at Dunedin Public Hospital. The Oral Health Impact Profile-20 (OHIP-20) was used to assess OHRQoL. RESULTS: One in three (36.0%) had been living independently at home prior to admission, and over half (55.0%) had been admitted for a medical reason which required assessment. Half (50.0%) of the participants were dentate (with an average of 16.8 teeth). There was an average of 1.9 decayed teeth present in the dentate group; 70.7% of individuals required restorations or extractions, and about 90% required only simple scaling of the teeth and prophylaxis. A reline or a replacement denture were required by three-quarters of those with dentures. Almost two-thirds of participants did not have a regular dentist, and fewer than one in three had made a dental visit in the previous year. One in six described their oral health as 'fair' or 'poor', and just under one-third reported dry mouth. Dentate participants, those without xerostomia, and those reporting better oral health had better OHRQoL, reflected in lower OHIP-20 scores. Affecting 37.1% of participants, functional limitation was the most commonly experienced of the OHIP-20 domains, followed by physical disability and physical pain (18.0% and 15.6% respectively). CONCLUSIONS: The oral health of medically compromised and functionally dependent but cognitively competent older people in this study is generally poor. If transfer to long-term care is indicated, early and proper preventive measures and appropriate dental contact should be advocated in order to reduce morbidity and improve quality of life for older people.

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.

Expanding prosthodontic services to the older patient in dental practices.

Numerous articles report on the unmet dental needs of the older patient, yet few have suggested strategies to overcome barriers to care for this unique demographic. At a time when prosthodontic services, including dental implants, offer improved outcomes, the elderly remain the least served of all patient groups. Obstacles to treatment include ageism, medical and dental complexity, financial limitations, and patients' resistance to treatment. Expanding prosthodontic care of the elderly requires a departure from traditional patient management techniques. The attempt to reverse ageism in your practice must go beyond simple awareness. Those offices that can relate to, treat with respect, and fulfill the health aspirations of the older patient create the atmosphere where care is more readily accepted. A successful team approach to patient management depends upon the ability to listen and respond to the elderly denture patient with information on denture maintenance and implant enhancements. An essential piece is encouraging regular recall for all denture wearers by every staff member. A well documented problem area in dental practice is the timely replacement of worn out or inadequate dentures. By using a simple assessment tool called the Satisfaction/Condition Score along with motivational interviewing, we have found increased treatment acceptance among our existing patients. Use of these suggestions in a general dentistry practice is more likely to encourage the older patient to better accept enhanced prosthodontic services.

Risk management in clinical practice. Part 6a. Identifying and avoiding medico-legal risks in complete denture prosthetics.

The provision of complete dentures is often perceived as a clinical 'black art' as it relies on a blend of clinical skill, scientific evidence and no little artistic interpretation. Coupled to this is a heavy reliance on patient ability to control their dentures in a muscular environment while, hopefully, coping with the various oral functions in addition to appearance. This article deals with the potential problem areas in the provision of complete dentures, reinforcing the importance of practitioners obtaining appropriate informed consent and of maintaining clinical knowledge and skills.

A randomized clinical trial comparing patient satisfaction and prosthetic outcomes with mandibular overdentures retained by one or two implants.

PURPOSE: This randomized clinical trial tested hypotheses that there are no differences in patient satisfaction, component costs, or treatment and maintenance times when mandibular overdentures are retained by one or two implants. MATERIALS AND METHODS: Subjects wearing conventional complete dentures were randomized to receive either one midline or two bilateral mandibular implants followed by a mandibular denture reline to incorporate implant retention. They indicated on a visual analog scale satisfaction with their dentures before implants and at 2 months and 1 year after implant retention. Satisfaction outcomes between the two groups were compared using the Wilcoxon/Mann-Whitney nonparametric rank test, while changes within each group were analyzed using signed-rank tests. Component costs and times for surgery, prosthodontic treatment, and maintenance were compared using nonparametric and t tests. RESULTS: Eighty-six subjects enrolled in this study and 85 completed the 1-year follow-up, at which median satisfaction was 93 (maximum 100) in the single-implant group and 94 in the two-implant group (P > .5). Within each group, median improvement in satisfaction was similarly dramatic (approximately 44) and significant (P < .001). Prosthodontic maintenance time was similar for both groups (P > .37), but the single-implant group had significantly lower component costs (P < .001) and lower times for surgery (P = .002), postsurgical denture maintenance (P = .021), and denture reline (P < .001). Five implants failed in four subjects, all in the two-implant group and all before denture reline. CONCLUSION: Lower component costs and treatment times, with comparable satisfaction and maintenance time over the first year, indicate that a mandibular overdenture retained by a single midline implant may be an alternative to the customary two-implant overdenture for maladaptive denture patients.

Denture repairs in different regions of Croatia in relation to prosthodontic teams.

The purpose of this paper is to evaluate the incidence of denture repairs in different districts of Croatia through the year of 2002. and to analyse the percentage of different repairs (relinings, simple repairs up to 2 elements and complicated repairs-more than 2 elements) in relation to prosthodontic teams. Data on the number of dentures, and the number and types of denture repairs delivered in the Croatian regions of Zagreb, Rijeka, Split and Karlovac were obtained from the Croatian Institute for Health Insurance for the whole of the year 2002. Information of the number of prosthodontic teams operating in those regions was also obtained. Proportionally more denture repairs were carried out in Karlovac (18%) than Split (5%). The smallest percantage of dentures that required relining was registered in Split and the highest in Rijeka (chi2 = 36.7, p < 0.01). The smallest percentage of simple repairs was registered in Rijeka and the highest in Split (chi2 = 24.3, p < 0.01). The smallest percentage of complicated repairs was registered in Split and the highest in Karlovac. In each region the proportion of denture repairs and types of repairs were correlated with a number of prosthodontic teams in that region. Karlovac had the smallest percentage of specialistic prosthodontic teams and the highest rate of denture repairs.

Prosthetic complications in an implant-retained mandibular overdenture population: initial analysis of a prospective study.

STATEMENT OF PROBLEM: The clinical success of implant-retained, tissue-supported mandibular overdenture prostheses has been documented. However, few studies have evaluated the return visits and associated cost required to maintain these prostheses. PURPOSE: The purpose of this investigation was to evaluate the amount of maintenance required to provide acceptable and satisfactory implant-retained mandibular overdentures in a prospective clinical trial. MATERIAL AND METHODS: Fifty-eight patients received new maxillary and mandibular complete dentures followed by placement of microthreaded/TiOBlast implants in the mandibular left and right canine regions. At 3 months, ball abutments were placed, and the mandibular prostheses were relined to receive Dalla Bona-type ball housings (baseline). Prostheses were prospectively evaluated, and adjustments were made at 3-, 6-, 12-, 24-, and 36-month recall visits and at nonscheduled visits for 9 types of prosthetic complications. RESULTS: Of 58 patients, 6 required no adjustments. The remaining 52 patients made 327 return visits (including 194 nonscheduled visits) for prosthesis and/or abutment adjustments. One hundred and fifteen practitioner hours were required to provide prosthetic solutions to patient concerns at the return visits. The total estimated cost for all professional and laboratory services was $12,624.00 ($218.00 per patient). CONCLUSION: Although mandibular implant-supported overdentures with Dalla Bona-type ball attachments are an acceptable treatment option for edentulous patients, routine maintenance is required to ensure successful long-term outcomes.

Assessment of shear bond strength between three denture reline materials and a denture base acrylic resin.

PURPOSE: This study reports the effect of five surface treatments on the bond strength established between three denture reline materials and a denture base resin. MATERIALS AND METHODS: Cylindric columns of denture reline materials were bonded to columns of denture base resins that received one of the surface treatments: application of dichloromethane, the monomer of the denture base resin, the recommended bonding agent or the monomer of the denture reline material, polishing with 240-grit silicone carbide paper, and air abrasion. A control group without surface treatment was included for each material. Specimens were immersed in water for 1 day and then thermocycled. The strength at which the bond failed under shear was recorded. RESULTS: None of the surface treatments significantly improved the bond strength of Kooliner. Triad bonding agent and denture base monomer applications most significantly improved the bond strengths of Triad and GC reline, respectively. CONCLUSION: Triad bonding agent and denture base monomer should be used in conjunction with Triad and GC reline, respectively, when relining a denture base resin.

The outcome of implant overdentures from a prosthodontic perspective: proposal for a classification protocol.

PURPOSE: This article proposes a classification protocol for reporting the outcome of implant overdentures. MATERIALS AND METHODS: Review of the literature pertaining to postinsertion prosthodontic procedures for maxillary and mandibular implant overdentures revealed a wide range in the terminology used and methods of reporting outcome, usually as a result of the use of varying designs among different implant systems. A need for comparative evaluation of the prosthodontic success of implant overdentures was identified. RESULTS: An existing classification protocol for implant-fixed prostheses containing six objectively defined fields was modified for implant overdentures. This new protocol, which also uses the descriptive fields of success, survival, unknown, dead, and retreatment (repair or failure), provides a method whereby postinsertion prosthodontic procedures and subsequent time to retreatment can be quantified regardless of design, method of attachment, or implant system. A ratio method for identifying prosthodontic treatment cost effectiveness of implant overdentures is included. CONCLUSION: This protocol could assist clinicians in their choices of implant overdenture therapy by providing accurate comparisons of varying implant overdenture systems and designs, and by identifying prosthodontic treatment cost effectiveness.

Denture treatment needs of an overdenture population.

Cross-sectional and longitudinal studies have identified that persons wearing overdentures require regular care and maintenance of their dentures and their remaining dentition. This paper reports on a longitudinal study of the denture treatment needs of 284 dentures placed in 254 patients seen over a period of 12 years. At placement of the overdentures, baseline measurements and photographs were made by a single examiner. These measurements included evaluation of the restorations, abutment height above the gingival margin, periodontal probing depths, and oral hygiene. Denture status was evaluated by examining stability, retention, the integrity of the denture bases, and the relationship of the teeth in centric occlusion. Denture hygiene was also assessed. Based upon this examination, the subjects' denture treatment needs were determined. The majority of overdentures were well tolerated, and in general the patients were satisfied with their dentures. The most common denture treatment need was cleaning, followed by adjustment of the denture bases. Relining was a more common problem in the mandibular arch than in the maxillae. The need for occlusal adjustment did not seem to be a problem after the fifth year, but this might have been because of replacement of worn teeth or dentures. The majority of denture repairs were necessitated before the sixth year. Patients who received immediate dentures did not have greater treatment needs. Looseness of the dentures was the primary complaint, followed by sore teeth and denture-bearing tissues. In spite of their complaints, the great majority of the patients were satisfied with their overdentures.

Fixed provisional restorations for extended prosthodontic treatment.

During extensive and extended prosthodontic treatment, there is need for a durable esthetic fixed provisional restoration that can be easily modified as treatment is completed and that is cost-effective. The needed strength of provisional restorations can be underestimated, and the management of complex treatment is then more difficult and the prosthetic results less predictable. Knowledge of the criteria for treatment restorations and the adequacies of their construction is essential for the prevention of catastrophic failures, patient management problems, and compromised results. Many times in complex prosthodontic treatment, changes are needed in esthetics, the plane of occlusion, incisal edge position, lip support, and type of occlusion, or the soft and/or hard tissues need to be altered or grafted surgically. In addition, after first- and second-stage implant surgery and extractions, there is a need for immediate tooth replacement with extended time between prosthodontic treatments. These prosthodontic changes and challenges can be addressed with reinforced acrylic provisional restorations that are adequately cemented and retained during the interim stage of healing and treatment. In addition, the provisional restoration should serve as a guide for the final restoration while esthetics and phonetics are evaluated for patient acceptance. This article describes the materials used with an indirect technique for fabrication of an extended-treatment acrylic provisional restoration that uses an internal cast metal support system for strength. This support system consists of metal bands or copings with extensions into edentulous areas and that have been opaqued to neutralize the metallic color. A matrix of vinyl polysiloxane made from the diagnostic wax-up simplifies construction of the acrylic, resulting in a strong, ridged, yet esthetic result.

Implant-retained mandibular overdentures: a simplified, cost-effective treatment approach.

The use of implant-retained complete overdentures is a viable treatment modality in compromised patients. Use of two separate implants in the mandible enhances the retention and stability of the denture, which is still mainly supported by soft tissues. A technique for clinical fixation of the internal attachment to a laboratory-rebased and tissue-loaded mandibular overdenture is described. The advantages, disadvantages, and the rationale of the treatment are presented.

A low-cost, portable removable prosthodontic treatment system for the compromised elderly.

The elderly population (people of 65 years and older), especially the compromised elderly, places an overwhelming demand on the health care system in the USA. Dentists must provide services to all segments of the elderly population, but the compromised elderly are labelled as 'poor' candidates for dental treatment because they are unlikely to cooperate, find it difficult to get to the dental surgery, or cannot pay for professional services. The authors of this paper have developed guidelines for on-site patient management using a team approach and a low-cost, portable treatment system for providing removable prosthodontic services using ligh-cured denture resin. The system is cost-effective, reduces chairside time and requires minimal patient cooperation but does not compromise the quality of care. Treatment can be provided in non-traditional settings with family members and support staff on-hand. The feasibility of this approach has been demonstrated by its use in hospitals, clinics, nursing homes and private residences.

Discrepancy between need for prosthodontic treatment and complaints in an elderly edentulous population.

Most reports indicate that about two-thirds of the elderly population have poor oral health but that only about one-third complain of a problem. The reason for this discrepancy has never been explained adequately. The objective of this study was to estimate the need for prosthodontic treatment in an edentulous elderly population, and to identify factors associated with complaints, needs for treatment, and the use of dentures. Interviews and examinations were conducted to determine the oral health and dental concerns among 269 residents of longterm care facilities in Vancouver. The need for prosthodontic treatment was considered under theoretical, clinical, and practical conditions, and related to various factors that might help to predict this need. During the interview, about half (54%) of the sample identified a problem, and 83% of the subjects were either using a denture with a major fault or were missing a denture. Seventeen percent of the sample would not benefit from treatment because of a severely resorbed residual ridge, while the presence of a complaint combined with a prosthodontic need indicated that about one-third (36%) would seek and benefit from treatment. The proportion of subjects with complaints was larger among the more educated subjects, and among those who had been recently to a dentist. It was not possible to predict the need for treatment from any of the socioeconomic factors considered. No significant association was observed between the need for treatment and the complaints, and many subjects seemed to be resigned to their discomfort or had unrealistic expectations from their dentures.

[Direct rebasing of temporary crowns in the fixed denture. An experimental assessment of the increase in heat at the pulp cavity level]. / La ribasatura diretta di corone provvisorie in protesi fissa. Valutazione sperimentale dell'incremento termico a livello della camera pulpare.

Self-curing resins are generally used to directly temporary prostheses on the crown abutments. This technique enables the operator to obtain a better marginal adaptation of the temporary prosthesis. The risk of such a procedure is the inflammation of the pulp due to the exothermic polymerization reaction of self-curing resins. The authors suggest experimentally evaluating the rate of thermic increase within the pulp cavity of an extracted tooth while directly relining a temporary crown.

Dental needs and dental service use patterns of an elderly edentulous population.

This study was undertaken to examine an elderly edentulous population to evaluate current dental needs and dental service use rates as well as to determine whether trends toward a reversal of this group's poor dental care habits are present. Of the 443 elderly individuals screened in the current study, 168 were determined to be edentulous in both dental arches. This means that 38% of the elderly population examined would at some time require dental services either to maintain their edentulous arches and related intraoral structures in a state of health or to fabricate new or maintain existing complete prostheses in a properly functioning condition. This figure is 12% lower than 1974 statistics, which indicated that 50% of the nation's elderly population were edentulous. A larger population would have to be surveyed to determine if this trend toward declining edentulousness is a national phenomenon or simply characteristic of the current population sample. Despite the lower proportion of edentulous individuals within the study population, some disturbing results were obtained. Although 92% of the population had complete dentures that they claimed were worn most or all of their waking hours, over 90% of these dentures were evaluated by examiners as requiring significant refinement (26%) or remake (69%). In addition, 58% of this group of individuals felt that they did not or were not sure whether they required current dental treatment; 58% also felt that the fit of their dentures was excellent or good. These figures demonstrated that only slightly more than half the study population was aware that their dentures were in need of corrective treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment needs of overdenture patients in a longitudinal study: five-year results.

This study evaluated the treatment needs of 44 overdenture patients who had worn their dentures for at least 5 years. There were 135 abutment teeth involved, 35 in the maxillae and 100 in the mandible. Recall rates varied from a low of 27.6% to a high of 73.7%. The attrition rate was 20.5% after 5 years. The caries rate varied from a low of 2.7% to a high of 20.6%, and periodontal treatment was required by 94% of the subjects after 5 years. Only 39.4% of the subjects required adjustments, repairs, relines, or remakes of their overdentures during this time. The study showed that the success of overdentures depended on maintaining oral hygiene at an adequate level and at least yearly recalls to maintain gingival health.

Removable prosthodontic treatment needs: a survey.

Population data on complete and removable partial prosthodontics in Iowa indicated the following. Denture wearers tend to be persons in the older age groups. The percentage of edentulous persons was lower than that reported nationally in 1971. Of every 1,000 persons, 156 were wearing dentures in one or both arches. Of every 1,000 persons, 53 needed a repair, reline, or replacement of an existing denture. Of every 1,000 persons, 70 needed a denture but were not wearing one. Persons of lower income and education were less likely to seek dental care but had the greatest need for treatment. Persons of lower income and education were at higher risk of having some form of mucosal lesions. The public will be unlikely to make use of dental services to prevent or treat lesions or to service a prosthesis unless they are specifically educated to do so.