Single-implant overdentures retained by the Novaloc attachment system: study protocol for a mixed-methods randomized cross-over trial.

BACKGROUND: Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients. METHODS/DESIGN: We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments' long-term wear and maintenance requirements. DISCUSSION: Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03126942 . Registered on 13 April 2017.

Provision of domiciliary dental care in North and West Belfast.

AIM: To determine the level of domiciliary care currently provided for patients by general dental practitioners (GDPs) and to investigate factors that influence the provision of domiciliary dental care in an area of high socioeconomic deprivation in North and West Belfast. METHOD: A descriptive study, involving a self-administered postal questionnaire sent to GDPs (n=89) in North and West Belfast. RESULTS: A valid response rate of 67% was achieved. Almost 20% of responding GDPs reported that they did not routinely offer domiciliary dental care. Of those who did, prosthetic treatment was undertaken most commonly, and other more time-consuming treatments such as fillings were referred to the Community Dental Services (CDS). Many GDPs reported not having a full range of domiciliary equipment, with only half of the GDPs surveyed carrying emergency drugs. Reasons cited for not providing the service were lack of time, the perception that patients would be too difficult to manage, and not having the appropriate equipment. The majority of responding dentists (85%) felt that domiciliary care should be referred to the community service. CONCLUSION: The rate of domiciliary care provision in North and West Belfast appears to be falling, despite it being an area of high socioeconomic deprivation where the demand for the service is growing. The general perception was that domiciliary care is too time-consuming, that the patients are too difficult to manage, and that there was a lack of appropriate equipment. As a result, the majority of GDPs in North and West Belfast felt that the CDS should care for all domiciliary patients.

Current update on portable dental equipment.

The dental care needs of the elderly are increasing as their population grows. For some of the elderly (eg, the nonambulatory, homebound, institutionalized), accessing dental care is a problem because they are unable to visit a traditional dental clinic. In the past, dental care has been taken to the homebound or institutionalized elderly by dentists using portable dental equipment. However, the perception that such equipment is difficult or impossible to obtain has limited the availability of on-site care. The purpose of this article is to describe various types of portable dental equipment and their features so that dentists interested in providing care to this group of patients are aware of them.

Provision of domiciliary dental care by Scottish dentists: a national survey.

UNLABELLED: Demand for domiciliary dental care is increasing as a result of a growing population of elderly and functionally dependent patients, legislative pressure and an increasingly dentate population. OBJECTIVE: To estimate the amount and types of dental care currently being undertaken on a domiciliary basis in Scotland and to examine the barriers to the provision of such care. METHOD: A descriptive study, involving a self-administered postal questionnaire was employed. All general dental practitioners (n = 1,995) and community dental officers (n = 200) in all Health Board areas across Scotland were included in the postal survey. Data were analysed in SPSS. RESULTS: The valid response rate was 66%. Sixty-seven percent of dentists undertook at least one domiciliary visit per year, mainly for elderly patients. Prosthetic treatment was undertaken most commonly. Other types of treatment were delivered mainly by the community dental service. Many dentists did not carry a light source or emergency essential drugs and half of the dentists overall were not confident to administer emergency drugs. Significant problems were identified in relation to the packaging and carriage of contaminated instruments and clinical waste. Of those respondents not providing domiciliary care, 19% stated that they would never consider doing so. Barriers to the provision of domiciliary care included time, poor remuneration, concerns about infection control, emergency drugs and lack of suitable equipment, and the difficulties of carrying equipment. CONCLUSION: Staff training, specialist equipment and new service models for the delivery of domiciliary care are required.

Caregivers' perceptions of electric versus manual toothbrushes for the institutionalised elderly.

OBJECTIVE: To evaluate how caregivers feel about the use of electric vs. manual toothbrushes for the elderly in long-term care. MATERIALS AND METHODS: After electric toothbrushes had been accessible in an institution for 15 months, a self-administered questionnaire was distributed to the nursing staff. The questions posed were whether the electric toothbrushes were being used, how much time was spent on brushing and if electric toothbrushes simplified the provision of oral care for the residents. RESULTS: The response rate was 79%. Of the 119 respondents, 78% replied that they always or frequently used an electric toothbrush. With regard to brushing times, 44% of the respondents reported that they spent less time on oral care procedures with an electric toothbrush than with a manual one. Equal amount of time for both types of toothbrushes was reported by 53%. Only 3% reported spending more time with an electric toothbrush than with a manual one. Oral care procedures were considered simpler with this device by 63% of the respondents, 22% registered no change and 15% found it more difficult. If patients suffering from dementia were considered separately, 45% found the procedures simpler when using electric toothbrushes, 24% registered no difference and 31% found it more difficult. CONCLUSION: The findings indicate that when given the choice, the caregivers prefer to use electric toothbrushes rather than manual ones as they feel this is simpler and often less time-consuming.

Setting up a mobile dental practice within your present office structure.

Different service models have emerged in Canada and the United States to address the issue of senior citizens' lack of access to comprehensive dental care. Over the past decade, one such model, the use of mobile dental service units, has emerged as a practical strategy. This article describes a mobile unit, operated as an adjunct to the general practitioner's office and relying mainly on existing office resources, both human and capital, to deliver services at long-term care institutions. The essential components of a profitable geriatric mobile unit are described, including education, equipment, marketing research and development, and human resource management. Issues related to patient consent and operating expenditures are also discussed. Data from one practitioner's mobile dental unit, in Hamilton, Ontario, are presented to demonstrate the feasibility and profitability of this approach.

A new dental unit for both patients in wheelchairs and general patients.

OBJECTIVE: To develop a dental unit to accommodate both patients in wheelchairs and general patients, and to evaluate the acceptability of the new chair for patients and dentists. DESIGN: To integrate a unit for patients in wheelchairs and a unit for general patients into a single dental unit. RESULTS: (1) The newly developed dental unit could be used for both patients in wheelchairs and general patients and could be installed in nearly the same space as occupied by a conventional dental unit. (2) The dentists could take the home position because of the height-adjusting and tilting mechanisms. (3) The patients could be treated with a sense of assurance because of the wheelchair immobilizer and the safety devices. (4) The dentists could perform patient treatment safely. (5) As patients did not need to be transferred from their wheelchairs, assistance was unnecessary. (6) From the questionnaires, both patients and dentists rated the newly developed dental unit favourable. CONCLUSIONS: The new dental unit for patients in wheelchairs and general patients permitted dentists to perform and patients to receive dental treatment safely and in a comfortable position. Also, as a single unit could be used for treatment of both types of patients, it required no extra space. Therefore, it has the potential to be installed in the clinics of general dental practitioners to treat both groups of patients.

Developing an instrument to support oral care in the elderly.

BACKGROUND: The dramatic increase in the number of dependent elderly in developed countries has created a great need for their improved oral care. However, optimal oral care by caregivers is not possible because of time constraints, difficulty involved in brushing other individuals' teeth, lack of co-operation, and the lack of perceived need. Therefore, the development of an effective instrument simplifying and supporting oral care to relieve the strain on caregivers is a matter of some urgency. PURPOSE: In order to clean the mouths of elderly dependent patients, we have developed a new oral care support instrument (an electric toothbrush in combination with an antibacterial-agent supply and suction system). The purpose of the present study was to develop and evaluate a new oral care support instrument. METHODS: a) Plaque removal study: The plaque- removing ability of this new instrument in 70 outpatients was compared with the Plak Control D9011 (Braun Gillette Japan Inc.) as a control by means of the Turesky modification of the Quigley and Hein plaque index. b) Clinical study: The subjects were 10 dependent elderly who received oral care using the new oral care support instrument for two weeks. The plaque and gingival indices were used for clinical evaluations. RESULTS: a) Plaque removal study: Brushing with the new oral care support instrument removed significantly more plaque than with the Plak Control D9011. b) Clinical study: The new oral care support instrument allows a more effective removal of dental plaque and shows a significant improvement in the gingival indices in dependent elderly. CONCLUSION: It is concluded that the new oral care support instrument is effective and can be recommended for oral care in the dependent elderly.

Oral cleansers.

Toothette Disposable Oral Swabs are oral cleansers intended for hospital and nursing home patients who cannot practice normal oral hygiene methods. The foam applicator contains sodium bicarbonate and is grooved to facilitate the removal of thick ropy saliva. The Toothette Single Use System is a kit that includes the Toothette Disposable Oral Swab, tubes of moisturizer and Prox-A-Mint solution, which is an oral débriding agent. The swab can be connected to a suction apparatus, allowing a safe and thorough oral cleaning, which is particularly useful in intubated and non-responsive patients.

Maintenance of prosthetic treatment in a geriatric patient--case report.

A 76-year old female patient came to the Specialized Clinic for Long-Lasting Dentures of the Dental School of Ribeirão Preto, USP, for prosthetic treatment for the correction of the absence of several teeth. The patient's medical history and examination revealed the presence of psoriasis that had progressed to a rheumatoid arthritis-like condition causing motor deficits such as difficulty in picking up and holding a toothbrush. We proposed two acrylic removable partial dentures, with a chromium-cobalt metal support planned for the lower denture. For the maintenance of oral hygiene we proposed an acrylic resin device coupled to the toothbrush in order to increase the volume of the toothbrush, and consequently facilitate tooth brushing. This device, although simple, has permitted the patient to have a more independent and healthy life style.

Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population.

Oral hygiene and oral health are a major concern for long-term-care facility residents who are unable to care for themselves. In this six-week study, the efficacy of a sonic toothbrush (Sonicare) was compared with traditional manual brushing in a setting where hygiene care was provided by caregivers. Evaluations of plaque levels were made at baseline and at 2, 4, and 6 weeks according to the Silness and Löe index. The sonic brush was found to be significantly superior to the manual brush over the trial period (MANCOVA; p = 0.026). Plaque reduction at 6 weeks was found to be 38% with the sonic brush and 6% with the manual brush. The results indicate that the sonic brush may be an effective way to provide improved oral health to nursing home subjects when oral care is caregiver-provided.

Observations on 25 patients treated with ball-retained overdentures using the Astra Tech implant system.

Twenty-five adult patients with fully edentulous jaws, aged from 44 to 80 years were treated with seventy-one 3.5 mm diameter Astra Tech dental implants in the parasymphseal region. The length of these implants varied from 9 mm to 15 mm. Either two or three implants were inserted, subsequently exposed after a minimum period of 3 months, abutments and ball attachments placed. Full lower dentures incorporating gold alloy housings for ball-attachments were constructed. The average time that the implants were in situ was 4 years and 2 months, ranging from 1 year 3 months to 5 years and 7 months. Of the 71 implants placed, 67 achieved osseointegration-a success rate of 94%. The main complication was that of the ball-attachments becoming loose.

Replacement of a maxillary obturator using a denture-copying technique: a case report.

After maxillary resection, the success of an obturator is often dependent on the neuromuscular skills of the patient and his or her ability to adapt to the shape of the prosthesis. When an obturator has to be replaced, it is desirable to retain the general form of the prosthesis, particularly in an aging patient whose powers of adaptation are reduced. This article describes the use of a copying technique to replace a maxillary obturator. This method facilitated replication of major characteristics of the prosthesis and controlled modification of others, thus minimizing the patient's need to acquire new neuromuscular skills.