A bi-level intervention to improve oral hygiene of older and disabled adults in low-income housing: results of a pilot study.

OBJECTIVE: This paper describes the results of a bi-level intervention, using a cognitive-behavioral theoretical approach, to improve the oral hygiene of older adults and the disabled in community-based low income senior housing. METHODS: The bi-level pilot intervention consisted of an on-site tailored adapted motivational interviewing (AMI) session and two oral health fairs, supported by a resident campaign committee, to change community norms. All materials were available in English and Spanish. Participants completed a survey consisting of 12 domains that provided the basis for tailoring the AMI and shaping the campaigns. The domains were activities of daily living (ADLs), access to oral health information, oral hygiene status, dental knowledge, hygiene behaviors, importance of oral hygiene, self-efficacy/locus of control, diet, intentions, self-management worries/fears, perceived risk and dry mouth. MAIN OUTCOME MEASURES: Each participant received clinical assessments consisting of full-mouth plaque score (PS) and gingival index (GI) before the intervention and at three months. RESULTS: Twenty-seven residents with at least one tooth completed all phases of the study. The mean number of domains requiring attention was 4.5 (SD 1.6) with a range of one to seven. Mean baseline PS was 83% (SD 16%) which improved significantly to 58% (SD 31%); mean baseline GI was 1.15 (SD 0.61) and improved significantly to 0.49 (SD 0.46). CONCLUSIONS: This pilot study supports the feasibility and acceptability of a tailored oral hygiene intervention among older and disabled adults living in low income senior housing. Although a small sample, the study demonstrated significant improvements in both plaque and gingival scores three months after the bi-level intervention.

The dental status of dentate institutionalized older adults: consideration of retained roots.

Many studies have described the general dental findings in institutionalized older patients, but few studies have used standard dental indices to describe the dental status of these populations. Eighty-five dentate nursing home residents were examined by a single dentist. Dental findings were reported by means of the DMFS, DMFT, and RCI indices along with the D/DFS ratio for coronal and root caries. The mean DMFS, DMFT, and RCI were 97.0, 22.9, and 28.7%, respectively. The percentages of untreated coronal and root caries lesions, as measured by the D/DFS ratios were 65.4% and 85.4%, respectively. Forty-eight percent of the subjects had at least one retained root, with a mean of 1.0 for all 85 subjects. None of the dental findings was statistically significant in association with age, gender, or length of stay in the institution. In the population examined, no statistical or clinical differences in relation to age, gender, or length of stay in the institution were found. The dental status of a dentate older adult population can be accurately described by means of the standardized indices of DMFS, DMFT, and RCI along with the D/DFS ratios, with the caveat that these indices must be interpreted differently than when used with pediatric populations. Retained roots present a fifth surface at risk for root caries, the occlusal surface. The role of the occlusal root surface in the dental status of a population needs to be reported and analyzed.

Duodenal epithelial thymidine uptake in patients with duodenal ulcer or endoscopic duodenitis.

To evaluate the relationship between duodenal ulcer disease and duodenitis, duodenal epithelial cell renewal was measured in mucosal biopsies by the incorporation of [3H]thymidine. When 14 patients with duodenal ulcer were compared to 13 control subjects or 7 with endoscopic duodenitis alone, the crypt size was the same in all groups. Similar to other inflammatory processes of the gastrointestinal tract, patients with endoscopic duodenitis showed increased proliferative indices including a greater number of cells incorporating [3H]thymidine. In contrast, the proliferative indices from the duodenal mucosa of patients with duodenal ulcers did not differ from a control group. In a group of 6 patients with both endoscopic duodenitis and duodenal ulcer, the [3H]thymidine incorporation was intermediate between control subjects or patients with duodenal ulcer alone and those with endoscopic duodenitis alone. When subjects were divided according to the histologic appearance of the duodenal mucosa, those having chronic duodenitis demonstrated enhanced [3H]thymidine incorporation in comparison to a control group or patients with chronic active duodenitis (polymorphonuclear leukocytes present). Although there are many possible explanations of these findings, one may speculate that duodenal ulceration does not stimulate duodenal epithelial proliferation.

Is gastroduodenitis part of the spectrum of peptic ulcer disease?

Gastroduodenitis should be included with duodenal ulcer and gastric ulcer in the spectrum of clinical disorders that have different pathogenetic mechanisms but a similar clinical picture. Published results of a clinical, endoscopic, radiologic, and histologic study of 100 patients presenting with gastrointestinal symptoms revealed that 61% had classic and 39% had atypical manifestations of peptic ulcer disease. We could not clinically distinguish the 24 patients with ulcer crater (40% of the classic group) from the 25 patients with acute gastroduodenitis without crater (41% of the classic group). Preliminary data of a prospective study compared the treatment responses of 19 patients with gastroduodenitis and 39 patients with peptic ulcer disease. These patients were diagnosed endoscopically and restudied after treatment with a bland diet and antacids seven times per day for 8 weeks. The responses to therapy in gastroduodenitis and peptic ulcer were as follows: endoscopically, 63 and 80%, respectively; histologically, 74 and 65%, respectively; symptomatically, 47 and 65%, respectively. Preliminary data on the duodenal epithelial thymidine uptake revealed an increased proliferative index in duodenitis patients but not in patients with peptic ulcer or control subjects.

Clinical experience with flexible sigmoidoscopy in asymptomatic and symptomatic patients.

The purpose of this study was to evaluate the diagnostic yield of flexible sigmoidoscopy when performed as a routine procedure in asymptomatic patients over the age of 40 being referred for a complete physical examination. The preliminary results of this ongoing program are presented together with the diagnostic yield in 408 patients with symptoms and signs suggestive of colorectal disease who were of similar age (56.6 vs. 56.5 years) and sex distribution (79 percent male) to the asymptomatic population, and who underwent flexible sigmoidoscopy as an indicated part of their evaluation. In the 122 asymptomatic patients, the mean distance examined by the procedure was 50.8 cm with the instrument being advanced beyond the optimal rigid sigmoidoscopy distance of 20 cm in 100 percent of patients. Adenomatous and hyperplastic polyps were identified in 16 patients, 13.1 percent, in the asymptomatic group, a similar percentage to the symptomatic population, 15.4 percent. Adenomatous polyps were diagnosed in 7.4 percent of the asymptomatic subjects and 9.1 percent of the symptomatic group. Colonic cancer was diagnosed in 0.8 percent of asymptomatic patients vs. 3.2 percent of the symptomatic group (p < 0.05). Seventy-seven percent of the neoplastic polyps detected in the asymptomatic patients and 60 percent in the symptomatic group were beyond 20 cm from the anus. Diverticulosis was diagnosed in a similar percentage of patients, 13.1 percent in the asymptomatic and 10.0 percent in the symptomatic group. No complications were encountered and the procedure was well tolerated without analgesia. It is concluded that: (1) in an asymptomatic population over the age of 40, flexible sigmoidoscopy, as a routine examination, results in a diagnostic yield not possible with rigid proctosigmoidoscopy and which approaches that observed in a symptomatic population of similar age; (2) for the internist trained in this procedure, flexible sigmoidoscopy has a future role in the detection of colorectal lesions and as an interval screening examination for premalignant lesions and colorectal cancer in asymptomatic and symptomatic patients.

A year's experience in a clinic for obese diabetics.

The problem of obesity is not well dealt with in the ordinary diabetes clinic. We therefore started a clinic for obese diabetics, the principles of which are mentioned. We reviewed the results of its ifrst year's activity in relation to 80 patients who attended for at least 3 months, and found: (i) a very frequent family history of diabetes in first-degree relatives (59% among Coloured patients); (ii) very commonly, an abnormal ECG, suggestive of ischaemic heart disease (about 60%); (iii) very frequent serum lipid abnormalities, yet no correlation between high lipid levels and an abnormal ECT; (iv) a mean loss of 5,9 kg over 8,6 months for the 80 patients (mean loss of 10,4 kg by the 8 men); (v) patients who had been fat in childhood actually lost more weight than did those who became overweight only in adult life; and (vi) oral hypoglycaemic drugs and even insulin could frequently be discontinued. We believe the clinic is worthwhile.