Response shift in oral health-related quality of life measurement in patients with partial edentulism.

The purposes of this study were to determine whether a response shift was observable after partial denture treatment and to identify the predictors that influenced the response shift magnitude and direction. A total of 173 consecutive patients with no more than eight missing teeth who received implant-supported, fixed or removable partial dentures at Okayama University Dental Hospital were asked to complete a full-version Oral Health-Related Quality of Life (OHRQoL) questionnaire before (pre-test) and after treatment (post-test). Additionally, a short form (then-test) consisting of seven questions selected from the full version had its reliability verified and was utilised to retrospectively assess the pre-treatment OHRQoL status. The difference between the summary scores of the then-test and the pre-test determined the response shift magnitude and direction. The then-test mean score (22·9 ± 6·6) was significantly lower (worse OHRQoL) than that of the pre-test (26·4 ± 5·2). The response shift effect size was of moderate magnitude and negative direction (d = -0·78). A multiple regression analysis showed that age (younger patients) (P < 0·01), number of replaced teeth (fewer) (P < 0·01) and pre-test scores (lower) (P < 0·01) were the significant predictors for response shift. In conclusion, a response shift phenomenon with negative and moderate effect size was observed after partial denture treatment. The significant predictor variables were young age, fewer numbers of replaced teeth and lower pre-test scores.

Effect of HAART on salivary gland function in the Women's Interagency HIV Study (WIHS).

OBJECTIVE: To determine the impact of highly active antiretroviral therapy (HAART) on salivary gland function in human immunodeficiency virus (HIV) positive women from the Women's Interagency HIV Study (WIHS). DESIGN: Longitudinal cohort study. SUBJECTS AND METHODS: A total of 668 HIV positive women from the WIHS cohort with an initial and at least one follow-up oral sub-study visit contributed 5358 visits. Salivary gland function was assessed based on a dry mouth questionnaire, whole unstimulated and stimulated salivary flow rates, salivary gland enlargement or tenderness and lack of saliva on palpation of the major salivary glands. MAIN OUTCOME MEASURES: Changes in unstimulated and stimulated flow rates at any given visit from that of the immediate prior visit (continuous variables). The development of self-reported dry mouth (present/absent), enlargement or tenderness of salivary glands (present/absent), and absence of secretion on palpation of the salivary glands were binary outcomes (yes/no). RESULTS: Protease Inhibitor (PI) based HAART was a significant risk factor for developing decreased unstimulated (P = 0.01) and stimulated (P = 0.0004) salivary flow rates as well as salivary gland enlargement (P = 0.006) as compared with non-PI based HAART. CONCLUSIONS: PI-based HAART therapy is a significant risk factor for developing reduced salivary flow rates and salivary gland enlargement in HIV positive patients.

Plasmid DNA encapsulation and release from solvent diffusion nanospheres.

The first step toward hydrophobic polymer-based nanospheres for gene delivery is to encapsulate and release plasmid DNA. However, encapsulating large hydrophilic molecules in very small nanospheres has been difficult, and only a few examples exist in the literature. For example, maximizing protein and peptide as well as small molecule encapsulation requires adjustments in pH or addition of excipients to charge neutralize, and make less hydrophilic, the compound to be encapsulated. Following this model, we have used a cationic lipid to load and release plasmid DNA from nanospheres made by the phase inversion/solvent diffusion method.

The prevalence of xerostomia and salivary gland hypofunction in a cohort of HIV-positive and at-risk women.

The association of xerostomia and salivary gland hypofunction with HIV infection has been established for men but not for women. We investigated the prevalence of these conditions in a national cohort (n = 733) of HIV-positive and at-risk HIV-negative women. Participants in this prospective cross-sectional study were recruited from the Women's Interagency HIV Study (WIHS) at five outpatient USA clinics. Xerostomia was assessed based on "yes" responses to a dry-mouth questionnaire. Samples of unstimulated whole and chewing-stimulated whole saliva were collected under standardized conditions. The major salivary glands were also evaluated clinically. The prevalence of dry-mouth complaint, the absence of saliva upon palpation, and zero unstimulated whole saliva (flow rate = 0 mL/min) were significantly (p = 0.001) higher in HIV-positive women. Adjusted odds of zero unstimulated whole saliva were significantly (p = 0.02) higher in HIV-positive women vs. HIV-negative women (OR = 2.86; 95% CI, 1.23 to 6.63). Significant (p = 0.03) univariate association was found between zero unstimulated whole saliva and CD4 counts. Adjusted odds of zero unstimulated whole saliva were significantly (p = 0.02) higher for HIV-positive women with CD4 < 200 compared with those with CD4 > 500 (OR = 2.61; 95% CI, 1.17 to 5.85). Chewing-stimulated flow rates were not significantly different between seropositive and seronegative women. The prevalence of xerostomia and salivary gland hypofunction appears to be significantly higher in HIV-positive women relative to a comparable group of at-risk seronegative women. Immunosuppression levels measured by CD4 cell counts are significantly associated with xerostomia and salivary gland hypofunction in a population of HIV-positive women.

Comparison of whole saliva flow rates and mucin concentrations in healthy Caucasian young and aged adults.

Unstimulated and chewing-stimulated whole saliva samples were obtained from 42 healthy Caucasians; 21 were between 18 and 35 years of age, and 21 between 65 and 83 years of age. The unstimulated salivary flow rate was significantly lower in the aged group, but the stimulated flow rate was significantly higher in the aged than in the young group. Both groups showed significantly increased flow during salivary stimulation. MG1 and MG2 concentrations in unstimulated and stimulated saliva samples were significantly lower in the aged group. There were no significant correlations between salivary flow rates and MG1 and MG2 concentrations.

Dental caries in HIV-seropositive women.

Reports that compare dental caries indices in HIV-seropositive (HIV+) subjects with HIV-seronegative (HIV-) subjects are rare. The objective of this study was to determine if there was an association between HIV infection and dental caries among women enrolled in the Women's Interagency HIV Study. Subjects included 538 HIV+ and 141 HIV- women at baseline and 242 HIV+ and 66 HIV- women at year 5. Caries indices included DMFS and DFS (coronal caries) and DFSrc (root caries). Cross-sectional analysis of coronal caries data revealed a 1.2-fold-higher caries prevalence among HIV+ women compared with HIV- women. Longitudinally, DMFS increased with increasing age and lower average stimulated salivary volume. Root caries results were not significant except for an overall increased DFSrc associated with smoking. Anti-retroviral therapy was not identified as a risk factor for dental caries.

Accuracy of diagnoses of HIV-related oral lesions by medical clinicians. Findings from the Women's Interagency HIV Study.

OBJECTIVE: To determine if medical clinicians are as accurate as dental clinicians in recognizing diagnostic characteristics of HIV-related oral lesions. METHODS: In 355 HIV-infected participants at five Women's Interagency HIV Study sites, we paired oral examinations conducted within 7 days of each other by dental and medical clinicians. We used the former as a gold standard against which to evaluate the accuracy of the latter. We assessed the accuracy of the medical clinicians' findings based both on their observations of abnormalities and on their descriptions of these abnormalities. RESULTS: Dental clinicians diagnosed some oral abnormality in 38% of participants. When "abnormality" was used as the medical clinicians' outcome, sensitivities were 75% for pseudomembranous candidiasis and 58% for erythematous candidiasis, but only 40% for hairy leukoplakia. When a precise description of the abnormality was used as their outcome, sensitivities were 19%, 12% and 20%, respectively. CONCLUSIONS: Medical clinicians recognize that HIV-related oral abnormalities are present in 40-75% of cases, but less often describe them accurately. Low sensitivity implies that the true associations of specific oral lesions with other HIV phenomena, such as time until AIDS, must be stronger than the literature suggests.

Response to anticoagulant drug withdrawal.

This study evaluated 44 separate medication withdrawal periods in 17 subjects who were attending a hospital anticoagulation clinic for management of anticoagulation medication. The data suggest that when anticoagulant withdrawal is needed for particular dental procedures, a 2-day hold is an effective period of medication withdrawal. No thromboembolic events were observed after any of the withdrawal periods. Further, no posttreatment hemorrhagic episodes were observed when the anticoagulant medication was reinstituted after dental treatment. Prothrombin time blood levels should be determined in the immediate pretreatment period, however, because the prothrombin time can fluctuate even in the best maintained patients.

Late infections in patients with prostheses for total replacement of joints: implications for the dental practitioner.

As more persons have prostheses that totally replace joints, dental practitioners should be aware of the complications, such as late bacterial infection of hematogenous origin, that can occur possibly as a result of dental treatment.

Pretreatment management of the patient receiving anticoagulant drugs.

This literature review suggests that certain low-risk dental treatment procedures can be performed in patients without altering their anticoagulant medications. Intermediate-risk dental procedures in these patients may be accomplished outside the hospital if the patient's prothrombin time value is within a specified range and if certain techniques are followed. In some cases, temporarily altering the dose of anticoagulant may be necessary. Patients receiving anticoagulant medications should continue to receive high-risk dental treatment in hospitals.

Cross-sectional comparison of dental students' knowledge and attitudes before geriatric training: 1984-1999.

The existence of negative attitudes toward aging and a lack of factual information has been voiced in the dental and other health professions. With increasing numbers of elderly in society, intergenerational social contact is more likely to occur and has the potential to reduce negative attitudes and increase knowledge about aging. The purposes of this study were to determine if the level of intergenerational social contact of dental students in one dental school had changed over the last fifteen years and whether any such changes were related to shifts in students' baseline knowledge about aging and attitudes toward elderly patients. Dental students (n=269) representing three different cohorts were surveyed about intergenerational contact, knowledge about aging, and attitudes toward elderly patients prior to receiving any geriatric training. Overall, findings revealed little evidence of increasing intergenerational social contact, an actual decrease in knowledge, an increased negative bias in knowledge, and unchanged attitudes toward elderly patients over the past fifteen years. Recent students were more likely to have had grandparents living in the family home, to have slightly less correct factual knowledge, and to be more negatively biased in their incorrect factual knowledge than earlier students. There were no differences in attitudes toward elderly patients among cohorts. We concluded that additional research is needed to confirm or refute our trends on a national scope. Should these trends be confirmed, dental educators would be alerted to the continuing necessity of countering the students' potential negative biases as well as a lack of basic knowledge about aging.

A controlled evaluation of computer assisted training simulations in geriatric dentistry.

The increasing number of geriatric dental patients and the development of treatment plans that require consideration of complex psychosocial, socioeconomic, and medical/medication factors necessitates a change in the traditional teaching of treatment planning. A computer-assisted instructional program was developed to simulate the dentist-geriatric patient interaction and to train students in clinical decision making for the geriatric patient. This study compared the effects of this program with a more traditional approach based on readings from the geriatric dentistry literature. Twenty third-year dental students were matched on grade point average and randomly assigned to the computer or literature-based groups. They were pretested using a clinical analogue of a geriatric patient and then instructed to use either the computer or literature-based educational units. The students were then post-tested on a second clinical analogue. Students performed similarly at pretest. At post-test, both the computer and literature-based subjects were found to have acquired significantly greater evaluation points, to make fewer errors, and to design more involved treatment plans than at pretest. Comparison of computer and literature-based subjects' performance revealed no significant main or interaction effects regarding type of educational unit used. Consistent nonsignificant trends were noted with the computer-based subjects out-performing literature-based subjects on each outcome variable. In addition, the computer-based subjects had more positive feelings about the educational unit than the literature-based subjects at a statistically significant level. These findings suggest that the computer program is an effective alternative method for developing clinical decision skills in students treating geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Systemic dissemination as a result of oral infection in individuals 50 years of age and older.

The oral pathosis caused by systemic disorders in middle-aged and elderly adults has been the focus of many publications in recent years. The intraoral soft and hard tissue changes associated with systemic disorders, medications, chemotherapy, and radiation treatment have been well-investigated and -documented. Far less attention has been paid to the role of oral infection as the etiology of systemic disorders. A literature review (1980-1994) is provided here focusing on well-documented cases in which systemic disorders were caused by oral foci of infections. This paper attempts to raise the level of awareness of practitioners in considering possible systemic complications caused by oral infection. It also emphasizes the need for further longitudinal studies in this field involving healthy and medically compromised elderly individuals.

Toxic shock and Down syndromes in a dental patient: a case report and review of the literature.

A literature review of Toxic Shock Syndrome is presented, including epidemiology, etiology, signs, symptoms and management, and its relationship to infection susceptibility in the Down Syndrome patient. A case of a Down Syndrome patient with Toxic Shock Syndrome is described, and the role of odontogenic infection is discussed.

A pilot study comparing three salivary collection methods in an adult population with salivary gland hypofunction.

The purpose of this pilot study was to compare the reliability of three collection methods (draining, chewing of gum base, and the Saxon test) for whole saliva using a sample of middle-aged and older ambulatory adults (n = 18) with proven salivary gland hypofunction. The results demonstrated high reliability (r values ranging from 0.91 to 0.80, p < 0.001) for all three methods. MANOVA analysis revealed significant (p < 0.001) differences in flow rates among the draining, chewing-stimulated, and Saxon methods.

Detecting diabetes in an elderly dental patient population.

The prevalence of both diagnosed and undiagnosed diabetes, a disease which has a significant impact on dental care delivery, increases with age. Because of these two factors, the dental practitioner must pay special attention to the detection of diabetes in this age group. This paper describes a study that validates the use of a simple blood test in conjunction with a questionnaire as a method to detect undiagnosed diabetes in an elderly dental patient population.

The changing profile of the HIV/AIDS epidemic.

The HIV/AIDS epidemic has undergone significant changes in the population affected and the opportunistic infections most commonly seen since the disease was first identified. Dental care providers must be aware of the changing profile of this disease in order to provide adequate assessment and treatment of their patients, and appropriate referrals to other healthcare providers.

Drugs commonly used by the elderly: a review for dental practice.

Of all medications consumed in the U.S., the percentage used by the elderly is greater than can be justified by their numbers. Many medications have adverse effects. This paper reviews the 50 medications most used by the elderly and discusses adverse reactions which may present in the oral cavity or which have systemic effects with a potential impact on dental care. Composite tables summarizing the adverse reactions of interest to the dental practitioner are included for easy reference.

The future of dental care for the elderly population.

The U.S. population is aging, and the elderly are maintaining many of their natural teeth. Studies have shown that if older people have teeth, they tend to utilize dental services to a similar extent as younger cohorts. Geriatric dental care is the diagnosis, treatment, and prevention of dental and oral diseases for all older adults. A functional categorization of the aging population is more useful in dentistry than a chronological one, and 70 percent of this population, or 23.2 million people, is able to visit a dentist in his or her office. The oral health care of older adults has become more challenging because they will no longer accept extraction and dentures as a solution to complex restorative needs. This paper discusses these issues and looks at the future of geriatric dental care.

HIV risk assessment: building on dentistry's history of promoting health.

Dentists have demonstrated a willingness to look beyond the mouth and consider the patient's overall presentation in a number of health-related areas. The HIV pandemic is another opportunity to involve the dentist in overall health issues through identification of those individuals at risk for acquiring HIV. This risk assessment activity can be facilitated through the use of a structured risk assessment algorithm that is presented in detail. The purpose of this algorithm is to encourage dentists--when they notice specific conditions or become aware of risky behaviors--to talk with their patients about HIV/AIDS and how the patient may be at risk. The historic success dentists have achieved in conveying information about the prevention of disease and promotion of health should bolster their resolve to expand their discussions with patients to include an HIV risk assessment.