Medication taking in a national sample of dependent older people.

BACKGROUND: Polypharmacy is associated with inappropriate medication use, and subsequently increasing older persons' risk of drug-related harm and health-related costs to individuals and society. OBJECTIVE: To examine and describe, using a national sample of patient-level medication data, the prevalence of older people's polypharmacy and medication use across dependency levels. To examine oral and general pain prevalence and associated analgesic usage. METHODS: Medication data from the 2012 New Zealand Older People's Oral Health Survey, a nationally-representative, cross-sectional study of dependent older people's oral health, were analysed descriptively, comparing classes and sub-classes of drugs and nutrient supplements taken across four categories of dependency: very low (own homes receiving in-home support), low, high and psychogeriatric (all receiving aged residential care). Self-reported current general pain and frequency of orofacial pain data were cross-tabulated by sub-classes of analgesics taken. RESULTS: All participants were taking at least one medication overall, 53.2% (95% CI: 50.4, 56.0) took between five and nine (polypharmacy), and 13.9% (95% CI: 17.4, 22.5) took 10 or more (hyperpolypharmacy). Antihypertensives, analgesics, antiulcer drugs, aspirin, laxatives, statins and antidepressants were the most common drug classes taken, the proportions differing between psychogeriatric level care and all other dependency groups. Overall, simple analgesics were taken (34.5%; 95%CI: 30.8, 38.4) more commonly than other analgesics; the use of nonsteroidal anti-inflammatory drugs was low (3.6%; 95% CI: 2.7, 4.7). Of those reporting experiencing extreme general bodily pain, 63.3% (95% CI: 56.6, 69.4) took an analgesic, more than those experiencing mouth pain occasionally or often. Fat-soluble vitamins were the most common vitamin supplement taken (32.0%; 95%CI: 27.0, 37.4). CONCLUSIONS: Polypharmacy and hyperpolypharmacy are common among older people, regardless of dependency level, and pain may be undertreated.

An in vivo study of the plaque control efficacy of Persica: a commercially available herbal mouthwash containing extracts of Salvadora persica.

AIM: This study compared the oral health efficacy of Persica mouthwash (containing an extract of Salvadora persica) with that of a placebo. DESIGN: In a double-blind, cross-over trial, participants were randomly allocated to use either the Persica mouthwash or a placebo for a three-week period. Plaque accumulation, gingival bleeding and the salivary concentrations of mutans streptococci (MS) were measured before and immediately following the experimental period. After an eight-week 'washout' period, the study was repeated with participants using the alternative mouthwash. PARTICIPANTS: Twenty-eight healthy students (aged between 18 and 42 years) volunteered to take part in this investigation. RESULTS: Compared with the pre-treatment values, both placebo and experimental groups demonstrated significantly reduced gingival bleeding (p < 0.01). Plaque scores were not significantly reduced following use of either Persica or the placebo. However, the use of Persica, but not the placebo, resulted in significant reduction in the carriage of MS (p < 0.05). CONCLUSION: Use of Persica mouthwash resulted in improved gingival health and lower carriage rate of cariogenic bacteria when compared with the pre-treatment values. The placebo (vehicle control) also improved gingival health significantly. Neither the Persica nor the placebo reduced the accumulation of dental plaque.

Changes in aspects of children's oral-health-related quality of life following dental treatment under general anaesthesia.

OBJECTIVES: This study was intended to examine the treatment-associated change in aspects of oral-health-related quality of life (QoL) among children (and their families) undergoing dental rehabilitation under general anaesthesia (GA). METHODS: The parents or caregivers of a consecutive clinical sample of children receiving comprehensive dental treatment under GA at the University of Otago School of Dentistry, Dunedin, and the Christchurch Oral Health Centre, Christchurch, New Zealand, were interviewed by telephone before and after the treatment. Questions were asked relating to the impact of the condition on the child and the family. The post-treatment questionnaire also sought information related to parental satisfaction with the care provided under GA. RESULTS: The parents or caregivers of 95 children participated in the study: 49 had treatment completed at the University of Otago School of Dentistry; and 46 were treated at the Christchurch Oral Health Centre. The child sample comprised 55.8% males and 44.2% females with a mean age of 5.1 years. Their mean dmft was 8.2. A consistent pattern of improvement was found with each indicator used. Complaints of pain, problems with eating and sleeping, and behaviour concerns showed significant improvements, with 100% improvement for children for whom frequent pre-GA problems associated with eating, sleeping and behaviour were reported. Sixty-six parents had to arrange time away from employment on the day of the GA and almost half of those incurred a loss of income. The majority of parents reported a high degree of satisfaction with the care received. CONCLUSIONS: Treating young children with high disease experience in a single session under GA results in immediate improvement in oral health and aspects of their QoL for both the children and their families.

Medications taken by 26-year-olds.

BACKGROUND: Most descriptive pharmacoepidemiological reports are from studies of older people, and little is known about medication use by younger adults. AIMS: The aim of the present study was to examine the prevalence of medication usage in the previous 2 weeks among young adults. METHODS: Detailed information was collected on medications taken by 26-year-old participants in the longstanding Dunedin Multidisciplinary Health and Development Study. RESULTS: At age 26, 980 (96.2%) of the surviving cohort participated; medication data were available for 978 individuals, of whom 78.1% had taken one or more prescribed or over-the-counter medications. Medication use was higher among females. The most prevalent drug categories were analgesics (taken by 22.8% of the sample), hormonal contraceptives (21.9%; 44.7% of females), nutrient supplements (17.6%) and anti-asthma drugs (11.1%). CONCLUSIONS: The prevalence and pattern of medication use among younger adults differ from those reported for older age groups. Asthma appears to be the most prevalent chronic medical condition requiring pharmacological intervention (and for which medical care has been sought) among younger adults. The low rates of use of antidepressants and anxiolytics suggest that common psychiatric disorders may currently go unrecognized or untreated among young adults, and the high prevalence of 'third generation' oral contraceptive use among females is of particular concern.

Risk indicators for tooth wear in New Zealand school children.

AIM: To investigate the prevalence and severity of tooth wear in the primary dentition of a representative sample of New Zealand school children and relate these to possible risk factors. DESIGN: A cross-sectional study. SETTING: Primary schools in Dunedin, New Zealand. PARTICIPANTS: 104 children of both sexes, aged between 5 and 8 years, randomly selected. METHODS: Clinical examinations of the buccal, occlusal/incisal and lingual surfaces of deciduous canines and molars. MAIN OUTCOME MEASURE: Degree of wear and the presence of dentinal cupping of teeth. Information on weaning and consumption of fruit-based drinks at bed time, frequency of consumption of fruits, yoghurt, pickled foods, fizzy and fruit-based drinks. RESULTS: The prevalence of tooth wear was similar in boys and girls and there were no significant differences between sides of the arches. A high percentage (82%) of children had at least one primary tooth with dentine exposed. While maxillary canines showed the greatest prevalence of dentine exposed, maxillary molars displayed the greatest prevalence of cupping. Severe tooth wear was less prevalent among children weaned after 12 months (14.3%) than those weaned earlier (27.9% P < 0.01). There were no statistically significant associations between wear and the consumption of fruit, yoghurt, pickled foods, fizzy drinks or fruit-based drinks. CONCLUSIONS: Tooth wear associated with dentine exposure is common in 5-8 year old children. This is not significantly associated with dietary factors, but appears to be related to early weaning from the breast.

Nutritional supplement use among 26-year-olds.

AIMS: To estimate the prevalence of use of nutritional supplements among young adults, to examine the source of those supplements and to investigate sex differences in usage. METHODS: Participants in the age-26 years assessments of the Dunedin Multidisciplinary Health and Development Study were asked to bring containers for any medication (including supplements) taken in the previous two weeks. Medication data (including prescription source) were recorded and analysed for 978 of 980 Study members. RESULTS: The prevalence of supplement use was 16.6%; 20.4% among females and 13.3% for males (p<0.01). Multivitamin preparations were the most widely consumed, followed by water-soluble vitamin supplements (such as folate and vitamin C). Folate use was higher among females and was taken by 35.7% of pregnant females. Most supplements were self-prescribed, although a doctor had prescribed over one-third of the mineral supplements. Most supplements had been taken for weeks or months, rather than years. CONCLUSIONS: Nutritional supplement usage among young adults is reasonably common, and involves a wide range of preparations. The extent of use among younger people suggests a need for regulation of their manufacture, sale and usage, and research to examine their efficacy.