Tooth loss and dementia amongst older adults residing in long-term care facilities in Vancouver: A case-control study.

OBJECTIVE: The purpose of this case-control study was to determine the association between dementia and the number of missing teeth, functional occlusal units and denture use in older adults residing in Long-Term Care (LTC) facilities. BACKGROUND: Many studies have shown an association between dementia and tooth loss. However, few studies with a large sample size have been reported describing the relationship between dementia and the number of missing teeth, remaining teeth and functional occlusal units. METHODS: An oral health assessment database of 2160 older adults admitted to LTC facilities in Vancouver, Canada, between 2015-2019 was utilised. Participants with a diagnosis of dementia in their medical records (N = 1174) were compared to those without dementia (N = 986). Multiple logistic regression analysis was used to explore a potential association between the number of missing teeth, functional occlusal units and the use of dentures and dementia. RESULTS: The number of remaining teeth (OR = 1.0, 95% Confidence Interval = 1.0-1.0; P = .054) and number of functional occlusal units (OR = 1.0, 95% CI = 1.0-1.0; P = .059) were not associated with dementia after adjusting for age, sex, oral self-care and systemic conditions. Denture use (OR = 1.1, 95% CI = 0.5-2.4; P = .790) was not associated with dementia in edentulous patients. CONCLUSION: There was no association between dementia and the number of remaining teeth, functional occlusal units or wearing dentures.

Impact of the COVID-19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service.

BACKGROUND AND OBJECTIVE: In Canada, the COVID-19 pandemic was associated with significant morbidity and mortality in older adults, particularly those in long-term care (LTC). Access to oral health services was limited during the pandemic due to public health restrictions. The aim of this paper was to describe the impact of the pandemic on the clinical education and service of the University of British Columbia (UBC) Geriatric Dentistry Program (GDP), which provides care to LTC residents. METHODS: Data were collected from UBC GDP AxiUm dental software records, including number of dental appointments in 2019 and 2020. Data on revenue in 2019 and 2020 based on clinical production were collected through financial summary reports. Data on the number of educational rotations were collected from summary reports from scheduling software. RESULTS: In 2020, significant reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. The number of GDP appointments for June-December 2020 was lower by 68%. The clinical productivity reduced by 67% for the same period. Expenses were slightly reduced. The overall number of LTC clinical rotations for students were only slightly lower for undergraduate students in 2020 than in 2019, and it increased for graduate students. CONCLUSION: The COVID-19 pandemic and associated public health restrictions had a negative impact on the clinical service and productivity of the UBC GDP in 2020 relative to 2019. However, clinical educational rotations to LTC were slightly increased in 2020 relative to 2019. Dental care for LTC residents can be provided if rigorous administrative controls, engineering controls and personal protective equipment are employed.

Clinical accuracy and reproducibility of virtual interocclusal records.

STATEMENT OF PROBLEM: Although in vitro studies have investigated the accuracy of virtual interocclusal records, clinical research on their ability to register virtual dental casts accurately is lacking. PURPOSE: The purpose of this clinical study was to evaluate the accuracy and reproducibility of the virtual interocclusal records of an intraoral scanning system compared with conventional polyvinyl siloxane (PVS) interocclusal records. MATERIAL AND METHODS: Three conventional interocclusal records followed by 3 virtual interocclusal records per side per participant were made in 10 participants. Three sites of close proximity (SCP) and 3 sites of clearance (SC) per side per participant were identified on the transilluminated conventional interocclusal PVS records for a total of 60 SCP and SC. The presence or absence of these sites on the virtual interocclusal records was analyzed by using an independent software program. RESULTS: The sensitivity for correct identification in the virtual interocclusal record was 87%, and its specificity was 95%. The positive predictive value was 95%, and the negative predictive value was 88%. For reproducibility, 74% of the SCP were detected consistently for all 3 repeated scans, and 92% of the SCs were identified accurately. CONCLUSIONS: The accuracy of virtual interocclusal records in identifying interocclusal contacts is clinically acceptable. However, the method tends to miss interocclusal contacts rather than introducing false ones and can result in perforations between the opposing virtual casts. Repeated buccal occlusal scans made of the same side showed fair reproducibility, and this aspect would benefit from further investigation.

Changes in Oral Health and Treatment Needs for Elderly Residents of Long-Term Care Facilities Over 10 Years.

PURPOSE: This study aimed to examine the oral health status of seniors residing in Providence Health Care (PHC) long-term care facilities in 2002 and 2012. METHODS: Staff dentists with the University of British Columbia Geriatric Dentistry Program made a complete oral health assessment of 799 elderly residents of 7 long-term care PHC facilities in 2002 and 381 residents in the 5 remaining PHC facilities in 2012. The 2012 data were divided into those for 275 residents who had received treatment in previous years and 106 new residents. All consenting residents were examined by dentists using the clinical oral disorder in elders (CODE) index detailing their medical and oral health status and medications. On completion of the oral health assessment, the dentist documented the need for specific dental treatment and reassessment. RESULTS: Comparing the cohorts from 2002 and 2012, the mean age of the residents who had CODE assessments increased from 85 years to 86 years, the proportion of men increased from 31% to 35%, the mean number of medical conditions per resident remained unchanged (2.6 to 2.5), but the mean number of prescribed medications has increased from 4.0 to 4.6. The percentage of residents with natural teeth increased from 56% to 76%. The proportion of edentulous residents recommended for denture-related treatment decreased from 21% to 10%. The 106 new residents in 2012 had higher treatment needs than the 275 original residents, but fewer required extractions than in 2002. Although the mean number of teeth per resident examined increased from 14.6 to 17.4 over the study period, the need for restorations remained at 20%, and the need for extraction of teeth decreased from 22% to 6%. The proportion of residents with healthy periodontium increased from 14% to 21%, but the need for dental hygiene services increased from 43% to 80%. CONCLUSIONS: The profile of long-term care residents who consented to an oral health assessment changed over the first decade of the new millennium, with an increase in mean age and number of prescribed medications, number of retained natural teeth and the need for dental hygiene services, but a decrease in the need for extractions.

The influence of altering sintering protocols on the optical and mechanical properties of zirconia: A review.

OBJECTIVE: As a result of advancements in chairside technology and speed sintering techniques and increased esthetic demands of patients, efforts have been made to produce monolithic zirconia restorations that are highly translucent, strong, and dense. While methods for processing zirconia are well known, there is a tendency to modify the process parameters with the aim of decreasing the overall processing time and, in particular, the sintering time. This review provides clinicians with scientific evidence of the effects of altering sintering parameters used for dental zirconia on its microstructure, phase transformation, and mechanical and optical properties. MATERIALS AND METHODS: A systematic search of Embase and Medline using Boolean operators was performed to locate relevant articles. RESULTS: Eleven articles were selected for this review. The following characteristics of monolithic zirconia have been confirmed to be affected by alterations in sintering: the microstructure, mechanical properties, optical properties, wear behavior, and low thermal degradation. CONCLUSIONS: The alteration of sintering parameters has been found to alter the grain size, wear behavior, and translucency of zirconia. There is a lack of clinical studies that investigate the influence of altering sintering parameters or methods on the clinical performance of monolithic zirconia restorations. CLINICAL SIGNIFICANCE: Alteration of sintering parameters alters the microstructural, mechanical, and optical properties of zirconia. This will consequently impact the clinical performance of zirconia prostheses. Future clinical investigations are encouraged to support these in vitro findings.

Marginal Discrepancies of Monolithic Zirconia Crowns: The Influence of Preparation Designs and Sintering Techniques.

PURPOSE: The marginal fit is an essential component for the clinical success of prosthodontic restorations. The aim of this study was to investigate the influence of different abutment finish line widths and crown thicknesses on the marginal fit of zirconia crowns fabricated using either standard or fast sintering protocols. MATERIALS AND METHODS: Six titanium abutments were fabricated for receiving zirconia molar crowns. Crowns were designed virtually and milled from partially sintered zirconia blanks and divided into 12 groups (n = 10/group). Crowns in groups 1 to 6 were sintered by standard sintering, while those in groups 7 to 12 were sintered by fast sintering. Groups were further categorized according to abutment finish line and crown thickness: G1/G7 (0.5 mm chamfer, 0.8 mm thick); G2/G8 (0.5 mm chamfer, 1.5 mm thick); G3/G9 (1.0 mm chamfer, 0.8 mm thick); G4/10 (1.0 mm chamfer, 1.5 mm thick); G5/G11 (1.2 mm chamfer, 0.8 mm thick); G6/G12 (1.2 mm chamfer, 1.5 mm thick). The marginal gaps were assessed at 8 locations using digital microscopy. The linear mixed effect model analysis was performed at a significance level of 0.05. RESULTS: All vertical marginal gaps were within the clinically acceptable range (∼11-52 µm). G8 (FS, 0.5 mm chamfer, 1.5 mm thick) demonstrated the largest gaps (47.95 µm, 95% CI: 44.57-51.23), whereas G3 (SS, 1.0 mm chamfer, 0.8 thick) had the smallest marginal gap (14.43 µm, 95% CI: 11.15-17.71). A linear mixed effect models showed significant differences for the interaction between finish line × crown thickness × sintering (F = 18.96, p < 0.001). The lingual surfaces showed the largest gaps in both sintering protocols, while the mesial and mesiobuccal surfaces demonstrated the smallest gaps. CONCLUSIONS: There was a significant interaction between finish line widths, crown thickness, and sintering protocol on the marginal gaps in both sintering protocols; 1.0 mm finish line preparations with either 0.8 mm or 1.5 mm occlusal reduction had better marginal fit in both sintering protocols compared to 0.5 mm or 1.2 mm finish lines. Smaller marginal discrepancies were observed for standard sintering crowns with a 0.5 mm finish line and 1.5 mm occlusal reduction. Conservative occlusal reduction should be accompanied with a 1.2 mm finish line to obtain better marginal fit for full-contoured zirconia crowns.

The accuracy of virtual interocclusal registration during intraoral scanning.

STATEMENT OF PROBLEM: Evidence on the accuracy and reproducibility of the virtual interocclusal registration procedure and recommendations as to how to make a virtual interocclusal record are lacking. PURPOSE: The purpose of this in vitro study was to assess whether virtual interocclusal registration records made at different locations around the arch affect the alignment of virtual casts, and to assess whether quadrant and complete arch scans have different effects on cast alignment when they are articulated with virtual interocclusal records. MATERIAL AND METHODS: Three sites of close proximity (SCPs) and 3 sites of clearance (SCs) were identified in each sextant of mounted zirconia master models. The SCPs and SCs were confirmed by using shimstock foil and the transillumination of an interocclusal impression. Complete-arch and quadrant scans of the master models were made with an intraoral scanner and registered with different virtual interocclusal registration records. The SCPs and SCs indicated by the scanner's software and by independent software were compared according to the sensitivity, specificity, and predictive values of each method. RESULTS: Changed locations of SCPs were found depending on the location of the virtual interocclusal registration record. The intraoral scanner's software contacts had a higher sensitivity of 92.86% and a negative predictive value of 84.21% than the contacts revealed by the independent software that exhibited a sensitivity of 69.05% and a negative predictive value of 70.45%. However, the intraoral scanner software had a lower specificity of 41.03% and a positive predictive value of 62.90% compared with the independent software, which exhibited a specificity of 79.49% and a positive predictive value of 78.38%. The quadrant scans had a higher sensitivity than did the complete-arch scans. CONCLUSIONS: Different occlusal contacts are obtained from interocclusal registration scans in different segments of the dental arch. The difference is more obvious in complete-arch scans, where a tilting effect toward the site of the interocclusal registration scan was observed. Occlusal contacts obtained from interocclusal registration scans for quadrant scans had a higher sensitivity than did those for complete-arch scans.

Marginal Fit of Lithium Disilicate Crowns Fabricated Using Conventional and Digital Methodology: A Three-Dimensional Analysis.

PURPOSE: To compare the marginal fit of lithium disilicate (LD) crowns fabricated with digital impression and manufacturing (DD), digital impression and traditional pressed manufacturing (DP), and traditional impression and manufacturing (TP). MATERIALS AND METHODS: Tooth #15 was prepared for all-ceramic crowns on an ivorine typodont. There were 45 LD crowns fabricated using three techniques: DD, DP, and TP. Microcomputed tomography (micro-CT) was used to assess the 2D and 3D marginal fit of crowns in all three groups. The 2D vertical marginal gap (MG) measurements were done at 20 systematically selected points/crown, while the 3D measurements represented the 3D volume of the gap measured circumferentially at the crown margin. Frequencies of different marginal discrepancies were also recorded, including overextension (OE), underextension (UE), and marginal chipping. Crowns with vertical MG > 120 µm at more than five points were considered unacceptable and were rejected. The results were analyzed by one-way ANOVA with Scheffe post hoc test (α = 0.05). RESULTS: DD crowns demonstrated significantly smaller mean vertical MG (33.3 ± 19.99 µm) compared to DP (54.08 ± 32.34 µm) and TP (51.88 ± 35.34 µm) crowns. Similarly, MG volume was significantly lower in the DD group (3.32 ± 0.58 mm3 ) compared to TP group (4.16 ± 0.59 mm3 ). The mean MG volume for the DP group (3.55 ± 0.78 mm3 ) was not significantly different from the other groups. The occurrence of underextension error was higher in DP (6.25%) and TP (5.4%) than in DD (0.33%) group, while overextension was more frequent in DD (37.67%) than in TP (28.85%) and DP (18.75%) groups. Overall, 4 out of 45 crowns fabricated were deemed unacceptable based on the vertical MG measurements (three in TP group and one in DP group; all crowns in DD group were deemed acceptable). CONCLUSION: The results suggested that digital impression and CAD/CAM technology is a suitable, better alternative to traditional impression and manufacturing.

Incidence of dental caries among susceptible community-dwelling older adults using fluoride toothpaste: 2-year follow-up study.

OBJECTIVES: To explore reasons for the underuse of dental services covered by a government-funded program in Alberta. METHODS: In 2011, a survey questionnaire was sent to 4000 randomly selected clients of the Alberta Child Health Benefit and the Alberta Adult Health Benefit programs. Only respondents with children were included in the analysis. Reasons were explored among those who indicated that their children did not receive any dental services in the year before the survey. Difficulties faced by those who reported receiving at least 1 dental service were also noted. RESULTS: Among 795 respondents, 597 had at least 1 child. A total of 1303 children aged 1-19 years (mean age 11.79 years, standard deviation 4.2) were included in the analysis. Of these children, 443 (34.0%) had not received any covered dental services; the most common reason (50.7%) was no perceived need (interpreted from the replies "my child was too young" or "had no dental problems") followed by perceived insufficient coverage (38.6%). The most common challenge reported by dental care users was also insufficient coverage (44.9%). About 57% of parents were aware that annual fluoride application was covered by the program; however, only 34.3% of their children received fluoride and 14.2% had sealants. CONCLUSIONS: Low-income families underuse available dental benefits for children. Perceived need seems to be the primary determinant of use. Parental awareness about the coverage does not seem to promote the use of preventive measures for young children.

The scope of practice of geriatric dentistry in British Columbia (Canada): An exploratory study.

AIMS: The oral health needs of frail older adults are increasing with an aging population in Canada. The objective of this study was to explore the perceptions of dentists in British Columbia regarding their view of geriatric dentistry as a distinct scope of practice and in relation to special needs dentistry. METHODS AND RESULTS: Qualitative data were gathered thorough semi guided interviews of a purposeful sample of dental clinicians, educators and members of organized dentistry with specialized knowledge of oral health for frail older adults. Interviews were transcribed, coded, and analyzed using a thematic approach. Thematic saturation was reached with the 10 participants in this study. Through the method of interpretative description, patient, dentist, and systemic factors that shaped scope of practice for geriatric dentistry were identified as well as the broader skill sets required for geriatric dentistry. CONCLUSION: The study found that participants perceived geriatric dentistry as unique scope of practice from general dentistry requiring special knowledge in the management of challenges associated with aging with frailty as well as the ability to work in long-term care. Similar to special needs dentistry, geriatric dentistry requires person-centered care and emphasized the need for interprofessional collaboration in alternative care settings.

A comparison of the dental health of Brazilian and Canadian independently living elderly.

OBJECTIVE: To compare the dental status of Brazilian and Canadian elderly populations with respect to socioeconomic and quality of life factors. MATERIALS AND METHODS: A total of 496 adults aged 60-75 years, having four or more teeth, and physically and cognitively suitable for a clinical oral examination were included. Subjects answered questions concerning their lifestyle and completed the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. RESULTS: In all populations, the majority were females, aged between 60 and 65 years and married. Although the Canadian New Immigrant population had lower mean income, they had more remaining teeth (23.04 ± 6.1), more functional teeth (sound and restored teeth) (14.92 ± 5.7), more sound teeth (15.40 ± 7.6), but more carious teeth (2.97 ± 3.0). The Brazilian population had higher numbers of restored teeth (12.26 ± 6.8) and fewer remaining teeth (17.80 ± 7.6). In all populations, females, married and younger (60-65 years old) adults were more likely to retain 20 or more teeth. The mean GOHAI scores were similar for Canadians (40.55 ± 5.7) and Canadian New Immigrants (39.28 ± 6.5), but were higher than that among Brazilians (31.97 ± 8.9). CONCLUSIONS: The numbers of remaining teeth were related to greater education and higher income status for Brazilian and Canadian populations. However, Canadian New Immigrants with lower income and education retained more teeth than the other populations.

A 5-year follow-up of older adults residing in long-term care facilities: utilisation of a comprehensive dental programme.

OBJECTIVE: This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. BACKGROUND: Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. MATERIAL AND METHODS: A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. RESULTS: Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70-73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56-72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, chi(2) = 7.9, df = 2). CONCLUSION: Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.

Resin-bonded fixed partial dentures: what's new?

BACKGROUND AND OBJECTIVE: Dentists often question the use of resin-bonded fixed partial dentures (RBFPDs) for reliable restoration of tooth-bound edentulous spaces. Initial attempts at bonding fixed partial dentures on teeth resulted in early failure due to debonding. In the 1980s and 1990s, improvements in preparation methods, metal alloys and bonding techniques made the RBFPD a more predictable option. In this paper, we summarize recent information concerning its success and failure. METHODS: A MEDLINE search using key words describing RBFPDs was carried out to identify pertinent English articles appearing in peer-reviewed journals since 2000. RESULTS: The principle reason for failure of RBFPDs remains debonding of the framework from the abutment teeth. Selection of nonmobile abutment teeth, preparation to enhance retention and resistance form, choice of the appropriate alloy and metal, and tooth bonding technique are the keys to success. The use of cantilever and nonrigid attachments may decrease interabutment forces and reduce debonding of retainers. CONCLUSIONS: The survival rate of RBFPDs is still considerably lower than that of conventional fixed partial dentures. Although RBFPDs can be used in both the anterior and posterior regions of the mouth to replace 1 or 2 missing teeth, careful abutment selection, tooth preparation, alloy selection and bonding technique are critical for clinical success.

The development, implementation, utilization and outcomes of a comprehensive dental program for older adults residing in long-term care facilities.

This paper documents the experience of the University of British Columbia's Geriatric Dentistry Program (GDP) with emphasis on the dental treatment needs of patients during its first year of operation. The GDP provided access to dental care for residents of longterm care facilities, education for hospital staff concerning daily mouth care, education of dental students and an opportunity for research. The first year of clinical activity saw a small, yet significant, improvement in oral health for residents using the dental services. We hope that the outcomes of this new dental program for long-term care facilities will encourage dentists to provide care for this vulnerable population.

Insights from students following an educational rotation through dental geriatrics.

Little is known about how dental students respond to dental geriatrics. This article describes a qualitative analysis of reflective journals submitted over two years by ninety-two senior students who participated in a brief clinical rotation in long-term care facilities. We used an inductive interpretive approach to analyze the journals. Eight themes emerged from the analysis: 1) complexity of the institutional environment; 2) heterogeneity of the resident population; 3) multidisciplinary environment; 4) record keeping; 5) interactions with residents; 6) the difficulty of oral health care for frail residents; 7) bridging the gap between theory and practice; and 8) the emotional impact of the clinical experiences. Apparently, the students appreciated the opportunity to witness the complexity of care in a multidisciplinary context and to observe a practical program of oral health care. They described the rotations as unique and emotionally challenging but very worthwhile. Overall, they wrote positively about their experiences with the elderly residents, acknowledged the contribution of the rotation as important to their clinical maturation, and reported that the experience enhanced their appreciation of a dentist's professional responsibilities.

Caries management for institutionalized elders using fluoride and chlorhexidine mouthrinses.

OBJECTIVES: The effectiveness of either a 0.2% neutral sodium fluoride (NaF) solution or a 0.12% chlorhexidine (CHX) solution as a daily mouthrinse for controlling caries was tested against a placebo rinse in this 2-year randomized clinical trial among elders in long-term care (LTC) facilities. METHODS: At baseline, 369 recruits were examined clinically for caries and allocated randomly to one of the mouthrinse groups. RESULTS: After 2 years, 116 participants remained in the trial. The prevalence of caries and the dental status of the groups were similar at baseline and after 2 years. On average, each group lost less than one tooth per person, but the fluoride group compared with the others had significantly less caries and significantly more reversals from carious to sound dental surfaces at the end of the trial. CONCLUSIONS: We conclude that 0.2% neutral NaF mouthrinse every day does reduce the incidence of caries among elders in LTC facilities.

Elderly Canadians residing in long-term care hospitals: Part I. Medical and dental status.

BACKGROUND: Oral diseases and conditions have been identified as a significant problem for elderly residents of long-term care (LTC) hospitals in developed countries, yet little recent information is available for the Canadian population. OBJECTIVE: To describe the medical, dietary, oral microbial, oral hygiene and dental status of elderly Canadians living in LTC hospitals in Vancouver and surrounding communities. METHODS: A sample of 369 elderly dentate hospital residents (mean age 83.9 years, 281 women [76.2%]) were examined, and their medical status and medications, oral status and type of hospital were documented. Oral hygiene practices and diet (specifically intake of refined carbohydrates) were evaluated. Subjects with xerostomia and subjects taking medications with hyposalivary side effects were identified, and salivary Streptococcus mutans and Lactobacillus were cultured. RESULTS: The mean plaque index was 1.3; men had a higher plaque index than women and residents of extended care hospitals had a higher plaque index than those in intermediate care hospitals. The mean bacterial score per millilitre of saliva was 9.7 105 colony-forming units (CFU) for Streptococcus mutans and 1.6 105 CFU for Lactobacillus. On average, each subject had 6.3 sound teeth, and 9.3 teeth had been restored. CONCLUSIONS: Although almost half of the subjects had visited a dental office in their community within the past 5 years, the elderly hospital residents in this study had few remaining teeth and suffered from poor oral hygiene. Prevention strategies (such as diet, oral hygiene and antimicrobial agents) rather than dental interventions (such as restorations and extractions) alone may be needed to control oral diseases in this susceptible population.

Elderly Canadians residing in long-term care hospitals: Part II. Dental caries status.

BACKGROUND: Dental caries has been identified as a significant problem for elderly residents of long-term care (LTC) hospitals in developed countries, yet little recent information is available for the Canadian population. OBJECTIVE: To document the caries status of elderly dentate residents of intermediate and extended LTC hospitals in Vancouver and surrounding communities. METHODS: A dentist examined the teeth of 369 elderly dentate hospital residents (coronal and root surfaces) for caries. The medical, dietary, oral microbial, oral hygiene and dental status of the same subjects are documented and discussed in a companion article. RESULTS: Two hundred and ninety (78.6%) of the subjects had at least one carious lesion; 186 (50.4%) had coronal caries and 254 (68.8%) had root caries. On average, each subject had 3.8 carious teeth. The residents of extended LTC hospitals had significantly more carious coronal surfaces. Lactobacillus scores were correlated with the DMFS (decayed, missing, filled surfaces), the number of carious coronal lesions, the number of carious surfaces and the plaque index, but Streptococcus mutans scores were correlated only with DMFT (decayed, missing, filled teeth). CONCLUSIONS: Overall, the prevalence of dental caries among the elderly residents of LTC hospitals in this study was high, although almost half of the subjects had visited community dentists within the previous 5 years. Caries prevention strategies (specifically diet, oral hygiene and antimicrobial agents) rather than treatment alone may be needed to control caries in this susceptible population.

Bone level changes proximal to oral implants supporting fixed partial prostheses.

The success of oral implant treatment relies on the presence and maintenance of bone adjacent to implants. The monitoring of radiographic bone level changes provides valuable insight into the longevity of oral implants. The purpose of this study was to measure radiographic bone level changes proximal (mesial and distal) to Brånemark System) implants (Nobel Biocare AB, Göteborg, Sweden) supporting fixed partial prostheses. Measurements were used to determine mean bone loss for the first year of loading by the prosthesis and the mean annual bone loss for subsequent years. These results were then compared and contrasted with various characteristics of the individuals, treatment, and treatment outcomes. Fifty-five subjects with 69 fixed partial prostheses supported by 160 implants were followed over a 1 to 12-year period. A mean bone loss of 0.33 mm (SD 0.59) was measured for the first year of loading and a mean annual bone loss of 0.00 mm (SD 0.11) after the first year. The radiographic bone loss calculated for implants at the first year of loading was positively correlated with the mean annual bone loss thereafter. Males, younger individuals and those implants supporting distal extension prostheses lost significantly more bone in the first year of loading. Larger numbers of implants followed for longer periods of time are needed to further explore the effects of various aspects of treatment on bone loss.