Dental Restoration Longevity among Geriatric and Special Needs Patients.

INTRODUCTION: Although the population is aging and retaining more teeth, there is a lack of studies that address the longevity of dental restorations placed among older adults. OBJECTIVES: This study aimed to describe the survival trajectory of dental restorations placed in an outpatient population of geriatric and adult special needs patients over a 15-y span, with particular interest in the longevity of subsequent restorations in teeth that received multiple restorations over time. METHODS: Dental restorations of different types and sizes in patients aged ≥65 y treated between 2000 and 2014 at the University of Iowa College of Dentistry were followed until they incurred an event (i.e., restoration replacement, extraction of the tooth, or endodontic treatment of the tooth). Survival analysis and extended Cox regression models were used to generate hazard ratios for selected predictor variables. RESULTS AND CONCLUSION: A total of 9,184 restorations were followed among 1,551 unique patients. During the follow-up period, 28.7% of these restorations incurred an event, and overall the restorations had a median life span of 6.2 y. In multivariable regression models, after controlling for sex and age, a greater number of restoration surfaces were associated with higher risks of failure, and the initial restoration recorded in the database for each participant tended to have a lower risk of failure than that of restorations that included any of those same surfaces that were placed later. This information could be helpful to older adult patients considering various restorative treatment options during the dental treatment-planning and informed consent process. KNOWLEDGE TRANSFER STATEMENT: Informed decision making with regard to potential treatment options is an important component of health and well-being. The present study could contribute to the improved health of older adult dental patients by providing baseline information that clinicians can use as they discuss different restorative treatment options with these patients and their caregivers during the informed consent process.

Evidence-based dentistry skill acquisition by second-year dental students.

INTRODUCTION: Identification and assessment of Evidence-based dentistry (EBD) outcomes have been elusive. Our objective was to describe EBD skill acquisition during the second (D2) year of pre-doctoral dental education and student competency at the end of the year. METHODS: The first and fourth (final) curricular-required EBD Exercises (ie, application of the first 4 steps of the 5-Step evidence-based practice process applied to a real or hypothetical situation) completed by D2 students (n = 151) during 2014-2015 and 2015-2016 were evaluated to measure skill acquisition through use of a novel rubric with measures of performance from novice to expert. Exercises were evaluated on the performance for each step, identification of manuscript details and reflective commentary on manuscript components. Changes in performance were evaluated using the chi-square test for trend and the Wilcoxon signed-rank test. RESULTS: Seventy-eight per cent of students scored competent or higher on the Ask step at the beginning of the D2 year; scores improved with 58% scoring proficient or expert on the fourth Exercise (P < .001). Most students were advanced beginners or higher in the Acquire, Appraise and Apply steps at the beginning of the D2 year, with minimal growth observed during the year. Identification of manuscript details improved between the first and fourth Exercises (P = .015); however, depth of commentary skills did not change. DISCUSSION: Unlike previous investigations evaluating EBD knowledge or behaviour in a testing situation, we evaluated skill acquisition using applied Exercises. CONCLUSION: Consistent with their clinical and scientific maturity, D2 students minimally performed as advanced beginners at the end of their D2 year.

Functionalization of carbon fiber tows with ZnO nanorods for stress sensor integration in smart composite materials.

The physical and operating principle of a stress sensor, based on two crossing carbon fibers functionalized with ZnO nanorod-shaped nanostructures, was recently demonstrated. The functionalization process has been here extended to tows made of one thousand fibers, like those commonly used in industrial processing, to prove the idea that the same working principle can be exploited in the creation of smart sensing carbon fiber composites. A stress-sensing device made of two functionalized tows, fixed with epoxy resin and crossing like in a typical carbon fiber texture, was successfully tested. Piezoelectric properties of single nanorods, as well as those of the test device, were measured and discussed.

Dental participation in geriatric interprofessional education courses: A systematic review.

INTRODUCTION: Although the interdisciplinary management of the ageing individual is highly stressed, there is limited information on the outcomes of interprofessional education (IPE) activities of dental students in geriatrics. This systematic review aimed to identify studies with dentists participating in formal IPE courses in geriatrics and assess the outcomes reported. MATERIAL AND METHODS: Electronic databases (PubMed, EMBASE, CINAHL and Scopus), reference lists from relevant studies and cited papers were investigated. The inclusion criteria were as follows: about formal interactive learning; learners from at least 2 disciplines; including dentists; related to geriatrics; any study design; reporting any outcome; only full papers; published in peer-reviewed journals; English language. RESULTS: Of the 1259 records retrieved, 26 were assessed for eligibility based on defined inclusion criteria and 7 studies were included in the final analysis. Two studies reported specific outcomes for dentists with lower, or even negative, post-training scores for interprofessional collaborative practice competences compared to other disciplines, but only one of them used a previously validated scale. There were no reports on the effect of IPE courses on dental trainees' gerodontology skill improvements or on their attitudes towards the older persons. CONCLUSION: The existing evidence is insufficient to determine any outcomes of formal interprofessional training of dentists in geriatrics. More studies with better experimental design should be developed. Among the strengths of IPE in geriatrics are the interdisciplinary nature of geriatric care, the sharing of common geriatric competences among participating disciplines and the opportunity to use nursing homes as a training site.

An approach on defining competency in evidence-based dentistry.

INTRODUCTION: Assessment of evidence-based dentistry (EBD) knowledge and behaviour is hampered by lack of explicit competency criteria. This void impedes instructional design and assessment of student growth during the educational process. METHODS: Knowledge and cognitive domains supporting educational objectives in a pre-doctoral dental programme were identified for each level of the EBD five-step process. We articulated educational objectives with behavioural expectations for each level of skill acquisition at each step of the EBD process. Outcome evaluation criteria identify students' progressive level of skill acquisition from novice to expert. RESULTS: The educational objectives, type of knowledge, and nature of the cognitive process supporting these objectives are presented for each step of the EBD process. For example, educational objectives of the "Ask" step include (i) to construct a question from the patient presentation and knowledge limitations that addresses the clinical problem and (ii) to articulate the Problem, Intervention/Exposure, Comparison, Outcome (PICO) components. Achievement of these objectives requires both factual information regarding the PICO format and the cognitive process of understanding. Educational outcome criteria consistent with a competent clinician include clear articulation of the PICO with identifiable pieces that relate to the clinical situation. DISCUSSION: Assessment strategies for progression towards EBD competency are limited due to the complexity associated with evaluating EBD knowledge and behaviours. To evaluate performance, the EBD academic community must define competency expectations for entry into unsupervised general dental practice. CONCLUSION: This framework offers measurable outcome evaluation criteria to initiate a conversation with academic peers regarding current gaps in EBD assessment.

Correlation of previous experience, patient expectation and the number of post-delivery adjustments of complete dentures with patient satisfaction in a Brazilian population.

A number of variables may influence the outcome of complete denture therapy. The objective of this study was to verify possible correlations between previous experience with dentures, patient expectation and the number of post-delivery adjustments with patient satisfaction after treatment. One hundred patients (mean age 61·9 ± 10·3) rated their previous experiences with complete dentures and their expectations before and satisfaction after treatment on a visual analogue scale (VAS) using scores from 0 (worst results) to 10 (best results). The number of post-delivery adjustments and other patient-related clinical variables was also noted. Patient expectation scores were higher than previous experience scores and satisfaction after treatment scores. Positive and weak correlations were found between previous chewing experiences with complete dentures, with regard to chewing expectations and comfort of use. Phonetics and comfort of use in previous experiences presented a positive correlation with expectations for chewing, aesthetics, phonetics and comfort of use. Groups of patients with different levels of education presented significant differences in expectation scores regarding comfort of use as well. A negative and weak correlation was found between phonetics satisfaction and the number of post-delivery adjustments. Patients' expectations for the therapy were higher than their satisfaction after treatment. Previous experiences with complete dentures could slightly influence patients' expectations and satisfaction, whereas lower scores for previous experience with complete dentures caused lower scores for both expectation and satisfaction. Patients' educational levels and the number of post-delivery adjustments influenced negatively the expectations about comfort of use and patient satisfaction, respectively.

Overdenture retained by teeth using a definitive denture base technique: a case report.

This paper presents a technique involving the use of a definitive denture base to make overdentures. Cores with ball attachments were cemented over remaining lower teeth. Impressions of the edentulous maxilla and mandible were taken to obtain a definitive acrylic resin base. The definitive base of the mandible was perforated at the location of ball attachments and its female components were fixed to the base using acrylic resin directly in the patient's mouth. Wax rims were then made, jaw relationships recorded, teeth mounted and tried in, and the dentures were cured. This technique allowed for easy fixing of female components and better retention during the recording of jaw relationships, and can also be used in the construction of implant retained dentures.

Patients' expectations and satisfaction of complete denture therapy and correlation with locus of control.

Considering the importance of patients' satisfaction with complete denture therapy and the influence of psychosocial aspects and expectations regarding satisfaction with their dentures, the present study aimed to test for a correlation between locus of control profiles and expectations before and satisfaction after complete denture therapy. Sixty-four patients rated their expectations for aesthetic and functional results of complete denture therapy on a 10-cm visual analogue scale (VAS), using scores from 0 (worst results) to 10 (best results). A similar questionnaire was used regarding satisfaction after final denture adjustments. Patients also answered a locus of control questionnaire in the initial interview. ANOVA and a chi-squared test were used to test for correlations among ratings, patient gender and locus of control profiles. The significance level adopted was 0.05. The expectation ratings before treatment were significantly lower than the post-treatment completion ratings, both for aesthetics (P < 0.001) and function (P = 0.004). There was no correlation between locus of control profiles and patients' ratings or between gender and VAS scores. No correlation was found between locus of control profiles and scores for expectations before and satisfaction after complete dentures.

Biofilm microbial communities of denture stomatitis.

INTRODUCTION: Denture stomatitis is a common lesion that affects denture wearers. Its multifactorial etiology seems to depend on a complex and poorly characterized biofilm. The purpose of this study was to assess the composition of the microbial biofilm obtained from complete denture wearers with and without denture stomatitis using culture-independent methods. METHODS: Samples were collected from healthy denture wearers and from patients with denture stomatitis. Libraries comprising about 600 cloned 16S ribosomal DNA (rDNA) bacterial sequences and 192 cloned eukaryotic internal transcribed spacer (ITS) region sequences, obtained by polymerase chain reactions, were analyzed. RESULTS: The partial 16S rDNA sequences revealed a total of 82 bacterial species identified in healthy subjects and patients with denture stomatitis. Twenty-seven bacterial species were detected in both biofilms, 29 species were exclusively present in patients with denture stomatitis, and 26 were found only in healthy subjects. Analysis of the ITS region revealed the presence of Candida sp. in both biofilms. CONCLUSION: The results revealed the extent of the microbial flora, suggesting the existence of distinct biofilms in healthy subjects and in patients with denture stomatitis.

Bacterial diversity in aphthous ulcers.

INTRODUCTION: Recurrent aphthous ulcers are common lesions of the oral mucosa of which the etiology is unknown. This study aimed to estimate the bacterial diversity in the lesions and in control mucosa in pooled samples using a culture-independent molecular approach. METHODS: Samples were collected from ten healthy individuals and ten individuals with a clinical history of recurrent aphthous ulcers. After DNA extraction, the 16S ribosomal RNA bacterial gene was amplified by polymerase chain reaction with universal primers; amplicons were cloned, sequenced and matched to the GenBank database. RESULTS: A total of 535 clones were analyzed, defining 95 bacterial species. We identified 62 putative novel phylotypes. In recurrent aphthous ulcer lesions 57 phylotypes were detected, of which 11 were known species. Control samples had 38 phylotypes, five of which were already known. Only three species or phylotypes were abundant and common to both groups (Gemella haemolysans, Streptococcus mitis strain 209 and Streptococcus pneumoniae R6). One genus was found only in recurrent aphthous ulcer samples (Prevotella) corresponding to 16% of all lesion-derived clones. CONCLUSION: The microbiota found in recurrent aphthous ulcers and in the control groups diverged markedly and the rich variety of genera found can provide a new starting point for individual qualitative and quantitative analyses of bacteria associated with this oral condition.

Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil.

OBJECTIVES: To record self-reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions. DESIGN: Cross-sectional. SETTING: All the institutions for the elderly in Taubaté, Brazil. SUBJECTS: The entire population of these institutionalised elderly people (n = 553). INTERVENTION: The subjects were interviewed and underwent an oral examination. MAIN OUTCOME MEASURES: Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded. RESULTS: The average age of the subjects who knew their age (n = 364) was 74.9 years (+/-12.9), and 64.7% of the sample group were females. Denture-related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene-related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture-related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth-brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check-ups (p = 0.007). CONCLUSION: Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.

Self-reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues.

OBJECTIVES: This article aims to evaluate the habits of hygiene and usage of a sample group of Brazilian wearers of complete dentures. DESIGN: This study has a cross-sectional design. SETTING: It was performed in the dental clinic of the University of Mogi das Cruzes. SUBJECTS: A sample group of 236 complete denture wearers was selected. INTERVENTION: The individuals were interviewed and clinically examined. MAIN OUTCOME MEASURES: Most commonly used hygiene habits were assessed and recorded. Possible relationships between habits and oral conditions were also assessed. RESULTS: Dental treatment was sought by 43.6 % 10 years after their last dental appointment, 77.5 % declared they had been given no instructions regarding the hygiene of their dentures, only 22.9% said they had been instructed about oral hygiene, and 91.9% stated they had not been told to return for periodical review visits. Denture stomatitis was found in 42.4%, although 89% of these patients presented with no symptoms; 98.7% of the group brushed their dentures; 27.1% regularly immersed their dentures in chemical products; 26.3% removed their dentures overnight. A positive relationship was observed between the lack of recommendations regarding oral and denture cleansing and the presence of denture-related stomatitis and hyperplasia. Family income and periodicity of visits to the dentist were also found to be related. CONCLUSION: Mechanical cleaning is the most prevalent method of hygiene. Self-reported lack of guidance to oral care was statistically related to inflammatory oral conditions. Future research is necessary to clarify possible causal role between these factors.

Pollen spectrum of honey of "uruçu" bee (Melipona scutellaris Latreille, 1811).

In spite of the importance of the "uruçu" bee as honey producer of excellent quality, as well, potential pollinator both in agricultural and natural ecosystems, mainly in North-eastern Brazil, just some information is found in literature about sources that such bees utilize to collect nectar and pollen. The identification of the plants visited by Melipona scutellaris was accomplished with base on the analysis of pollen types found in the honey samples collected every two months, from March 1997 to February 1998, in 15 colonies located in Catu, State of Bahia, Brazil (12 degrees 21'00"S, 38 degrees 22'40"W, 76 m of altitude). Qualitative and quantitative analysis of the pollen types were carried out determining the percentage and occurrence classes. Twenty-eight pollen types were found, being considered dominant pollen, the Eucalyptus spp. and Psidium sp. types and secondary pollen, Bauhinia sp., Caesalpinia sp. and Mimosa verrucata types. It was verified dominant pollen of Eucalyptus spp. in honeys produced in November/December 1997 and January/February 1998. The families Caesalpiniaceae (14%), Mimosaceae (25%) and Myrtaceae (56%) were the most represented in the pollen spectrum.

Pollen spectrum of honey of "uruçu" bee (Melipona scutellaris Latreille, 1811)

In spite of the importance of the "uruçu" bee as honey producer of excellent quality, as well, potential pollinator both in agricultural and natural ecosystems, mainly in North-eastern Brazil, just some information is found in literature about sources that such bees utilize to collect nectar and pollen. The identification of the plants visited by Melipona scutellaris was accomplished with base on the analysis of pollen types found in the honey samples collected every two months, from March 1997 to February 1998, in 15 colonies located in Catu, State of Bahia, Brazil (12§21'00"S, 38§22'40"W, 76 m of altitude). Qualitative and quantitative analysis of the pollen types were carried out determining the percentage and occurrence classes. Twenty-eight pollen types were found, being considered dominant pollen, the Eucalyptus spp. and Psidium sp. types and secondary pollen, Bauhinia sp., Caesalpinia sp. and Mimosa verrucata types. It was verified dominant pollen of Eucalyptus spp. in honeys produced in November/December 1997 and January/February 1998. The families Caesalpiniaceae (14 percent), Mimosaceae (25 percent) and Myrtaceae (56 percent) were the most represented in the pollen spectrum

Case reports: evolution of prosthetic rehabilitation for a patient with severe loss of periodontal support.

This paper describes the development of a technique to make a fixed bridge for a patient with severe reduction of periodontal support. Initially, the bridge was temporarily cemented over copings. However, when the super-structure was periodically removed for inspection, the copings were easily dislodged, with a risk of fracture of the abutment teeth. Consequently, the technique was modified by using lateral screws to fix the bridge to the copings. This design allows easy periodical removal, cleaning, repair and inspection of the abutment teeth.

Diagnostic strategies in venous thromboembolism.

BACKGROUND AND OBJECTIVE: Diagnosis of acute deep vein thrombosis (DVT) and of pulmonary embolism (PE) is often difficult: symptomatic patients are usually investigated employing several diagnostic tests, which should be appropriately selected and sequenced, taking into account their sensitivity, specificity, safety and cost. The objective of this paper is to evaluate the performance of the new diagnostic tests and their combination in rational diagnostic strategies. DESIGN AND METHODS: A literature review was made using a Medline(R) database search for the period 1988-1998 on the following key words in various combinations: diagnosis, diagnostic strategy, venous thrombosis, pulmonary embolism, venous thromboembolism. Results of a new study by our group on diagnosis of DVT in hospitalized patients are also discussed. RESULTS: In patients with symptoms or signs suggestive of DVT, compression ultrasound (CUS) appears to be the diagnostic test of first choice, since it is a noninvasive test with high specificity and sensitivity for proximal DVT (about 97%). When CUS gives a negative result it is usually recommended that the test is repeated after one week, since its sensitivity for calf DVT is poor. The positive and negative predictive values (PPV and NPV) of CUS in symptomatic outpatients can be improved if adequate consideration is given to clinical diagnosis, using a standardized model (ref. #9), which allows symptomatic outpatients to be categorized as having a high, moderate or low probability of DVT. In case of agreement between clinical diagnosis and CUS results, no further testing is needed: patients with high or intermediate clinical probability and positive CUS results are treated, while in patients with low clinical probability and negative CUS results the diagnosis of DVT is excluded. In the case of discrepancy between clinical diagnosis and CUS results, D-dimer test and/or venography are requested. However in patients who develop signs or symptoms of DVT in the hospital the clinical model does not work, and diagnosis should be based on an appropriate mix of CUS, D-dimer (DD) test and venography. In patients presenting with signs or symptoms of pulmonary embolism, the ventilation/perfusion (V/P) lung scan remains a pivotal diagnostic test, and pulmonary angiography the reference standard, but both methods have limitations and in recent years other diagnostic tests such as echocardiography, helical (or spiral) computerized tomography, and magnetic resonance imaging have been introduced into clinical practice. Moreover, all four diagnostic tools mentioned for DVT diagnosis can be considered. Several diagnostic strategies have been proposed and evaluated in comparative studies but there is still debate over the most efficient test combination or sequence. INTERPRETATION AND CONCLUSIONS: Diagnostic strategies which include adequate consideration of clinical diagnosis using standardized models have the potential of being more efficient for outpatients (but not for inpatients) with symptoms or signs suggesting DVT of lower limbs. For patients with suspected PE, several diagnostic strategies have been assessed: V/P lung scan remains a pivotal diagnostic test, but its limitations have been increasingly recognized and newer non-invasive techniques are gaining credit. A consensus is still to be reached over the most appropriate combination of diagnostic tests.

Evaluation of circulating galanin levels after exercise-induced pituitary hormone secretion in man.

The neuropeptide galanin (GAL) is widely distributed in the central and peripheral nervous systems, anterior pituitary, and adrenal medulla. GAL is colocalized with corticotropin (ACTH) in the human pituitary and with epinephrine (E) and norepinephrine (NE) in chromaffin cells of the adrenal medulla. The function of GAL in peripheral tissues is not known, although the presence of the peptide in corticotrophs and the adrenal gland suggest that it participates in stress responses. In the present study, we investigated whether GAL is cosecreted with ACTH during activation of corticotrophs by an acute physical exercise test. Circulating levels of GAL and pituitary hormones were measured in healthy exercise-tested and control male subjects. Blood samples were collected during basal conditions, maximal power output (MPO), and the recovery period. Control subjects were sampled during the resting condition. The pituitary response to exercise was characterized by a significant increase in ACTH plasma levels (peak value 13.28 +/- 2.19 v 6.68 +/- 1.01 pmol/L, P < .05) and growth hormone (GH) serum levels (peak value, 14.53 +/- 5.59 v 0.29 +/- 0.1 microg/L, P < .02), with the peak in hormone levels detected 15 minutes after the end of exercise. No change in circulating prolactin (PRL) levels was detected. An expected significant increase in plasma levels of both E (peak value, 1,574.41 +/- 403.31 v 267.44 +/- 60.03 pmol/L, P < .01) and NE (peak value, 7,275.25 +/- 955.80 v 961.51 +/- 168.40 pmol/L, P < .01) was also observed. Plasma GAL levels were not affected by the acute exercise test, with the levels being comparable to baseline during the exercise test and the recovery phase. At any sample time, GAL values were comparable between exercise-tested and control subjects. These data show that despite the colocalization of GAL and ACTH within the same pituitary cells, the two peptides are not coreleased in response to stress resulting from acute physical exercise. Furthermore, pituitary GAL seems not to be involved in the stimulation of GH secretion in exercise-tested subjects. The results also indicate that GAL is not coreleased with E or NE in response to the exercise-induced stress condition.

Lipoprotein Lp(a) and cerebrovascular disease in the elderly: correlations with the severity of extracranial carotid atherosclerosis assessed by ultrasonography.

High levels of lipoprotein Lp(a) are related to cerebrovascular disease clinical manifestations, as well as to the severity of extracranial carotid atherosclerosis assessed by ultrasonography. In order to investigate the relationship of Lp(a) to the severity of carotid atherosclerosis in the elderly, 100 subjects, aged 78.5 +/- 0.6 yrs underwent an echo-color-doppler scanning of carotids; atherosclerosis severity, assessed as maximum percentage stenosis, presence of complicated plaque and Intima-Media Thickness (IMT), was related to Lp(a) levels, assayed by an immunoenzymatic procedure. A slight association between Lp(a) and CVD clinical manifestations was apparent only in subjects under 78 yrs and for Lp(a) values above 25 mg/dL. Lp(a) levels were not related either to the degree of stenosis, the presence of complicated plaque, or IMT. As for other selected risk factors, while no relationship was found for clinical CVD and IMT, the maximum percentage of stenosis and the presence of complicated plaques were positively related to LDL-cholesterol in subjects under 78 yrs. We can conclude that Lp(a), albeit unrelated to the severity of extracranial vessel atherosclerosis, maintains a role as cerebrovascular risk factor in the elderly, being slightly related to clinical manifestations; however its discriminant power is lower than in middle-aged people and further decreases throughout ageing.