RÉSUMÉ
OBJECTIVE: This study evaluated the quality of nutritional uptake of the care-dependent, community-dwelling older adults. METHODS: Community-dwelling care-dependent elders were recruited in this study. The food items along with their nutritional content were extracted from the participants' refrigerators and categorized according to the NOVA classification (G1: unprocessed/minimally processed; G2: processed culinary ingredients; G3: processed; G4: ultra-processed). The nutritional information of the food items was entered into a dietary analysis software that analyzed the content. Data was verified for a normal distribution and non-parametric tests were applied for statistical analysis (p < 0.05). RESULTS: 100 subjects (mean age = 81.1±9.5 y; mean MMSE: 26.6±6.8) participated in this study. The participants had significantly more G1 than G2, G3 or G4 (p < 0.001) foods. Women had more G1 items in their refrigerators than men (rs = 0.372, p < 0.001). Higher socio-economic status indicated a presence of more G1 (rs = 0.313, p = 0.002), G2 (rs = 0.342, p < 0.001) and G4 (rs = 0.237, p = 0.024) foods. Higher cognitive scores revealed an increase in presence of G4 (rs = 0.238, p = 0.023) items. Participants with an increased need for assistance had less G2 (rs = -0.332, p = 0.001), and G4 (rs = -0.215, p = 0.041) foods; age had no influence. CONCLUSION: The findings of this study confirm that the majority of care-dependent, community-dwelling adults procured healthy dietary aliments for their daily living; however, whether this correlated to the actual nutritional state of these older adults needs to be further investigated. This highlights the need for further investigation and tailored interventions to ensure good nutrition, emphasizing regular assessments and comprehensive support beyond just food access. CLINICAL RELEVANCE: Clinicians must recognize that access to healthy food alone may not ensure good nutrition in older adults. Regular nutritional assessments, personalized dietary interventions, and additional support services like meal preparation assistance, nutritional counseling, and tailored programs are essential to address specific dietary needs and preferences.
Sujet(s)
Vie autonome , Humains , Femelle , Mâle , Sujet âgé , Sujet âgé de 80 ans ou plus , État nutritionnel , Valeur nutritive , Régime alimentaire , Évaluation gériatrique , Évaluation de l'état nutritionnelRÉSUMÉ
The aim of this study was to assess the oral health status (OHS), Oral health impact profile (OHIP-G-14), and the nutritional status (NS) in community-dwelling, dependent older adults. Information on OHS including DMF(T), plaque (PI) and gingival (GI) indices, community-periodontal-index-for-treatment-needs (CPITN), OHIP-G-14, maximum bite force (MBF), chewing efficiency [subjective (SA) and quantitative (VoH) assessments] were collected. NS was obtained by Mini-nutritional assessment (MNA) and body mass index (BMI). Cognitive status was evaluated by the mini-mental state examination (MMSE). 240 elders (mean-age = 81.5 ± 8.9y; men =85, women =155) were recruited. Average number of teeth, functional occlusal units and DMF(T), were 18.8 ± 8.9, 7.7 ± 3.5, and 22.3 ± 5.3 respectively. Mean PI, GI, CPITN and OHIP-G-14 were 1.8 ± 0.8, 1.2 ± 0.8, 1.9 ± 1.1, and 8.0 ± 12.0, respectively. MBF, VoH, SA were 219.6 ± 193.6, 0.3 ± 0.2, and 3.3 ± 1.4, respectively. MNA and BMI were 22.9 ± 4.7 and 25.5 ± 5.3, respectively. Number of teeth reduced significantly with age (P < 0.001), cognitive decline (P < 0.001). Oral hygiene significantly deteriorated with cognitive decline (P < 0.001). OHIP scores were negatively affected by increasing cognitive decline (P < 0.001). MNA deteriorated in women (P = 0.026), with increasing age (P = 0.015), and advancing cognitive decline (P < 0.001). BMI reduced with advancing age (P = 0.003) and in women (P = 0.016). Based on the findings of this study, it may be concluded that advancing age and cognitive decline, negatively impacted the oral health, oral function, oral health-related quality of life, and the nutritional state of care-dependent community-dwelling older adults.
Sujet(s)
Vie autonome , État nutritionnel , Santé buccodentaire , Humains , Femelle , Mâle , Sujet âgé de 80 ans ou plus , Sujet âgé , Suisse , Indice de masse corporelle , Indice parodontal , Évaluation gériatrique , Qualité de vieRÉSUMÉ
Masticatory muscle activation and temporomandibular joint (TMJ) load generated during asymmetrically loaded jaw closing are largely unknown. Two different strategies were developed to explain how the central nervous system (CNS) generates muscle activation patterns during motion: minimization of joint load (MJL) vs. minimization of muscle effort (MME). The aim of the present study was to investigate, experimentally, the neuromuscular strategy selected by the CNS to coordinate jaw closing in reaction to the application of an external asymmetric load. Masticatory muscle activation was measured with electromyography (EMG) and the minimum intra-articular distance (MID) was assessed by dynamic stereometry to infer joint loading. Ten healthy subjects performed jaw-closing movements against an asymmetric mandibular load set from 0.0 to 2.0 kg in 0.5-kg steps. Recordings were analyzed by exploratory and graphical statistical tools. Moreover, the observed differences in MID and EMG among the various mandibular loads were tested using non-parametric tests for repeated measures data. The ipsilateral-contralateral differences in MID and EMG of the anterior temporalis showed a significant increase (p < 0.001, p = 0.01) with increasing asymmetrical load with both joints being most heavily loaded at 1 kg. EMG signals of the masseter did not change significantly with increasing load. This study is the first to have analyzed the changes in the TMJ intra-articular space during asymmetrically loaded jaw-closing movements, not only three dimensionally and dynamically, but also combined with EMG. Asymmetrical load affected the TMJ space and masticatory muscle activation patterns, primarily resulting in an increased activation of the anterior temporalis muscle. This might suggest the involvement of a control mechanism to protect the joints from overloading. However, the results do not fully support the hypothesis of MJL nor the MME strategy.
Sujet(s)
Endrine/analogues et dérivés , Muscles masticateurs , Articulation temporomandibulaire , Humains , Mandibule , Système nerveux central , ÉlectromyographieRÉSUMÉ
OBJECTIVES: This review evaluated the effects of rehabilitation with implant-supported prostheses on the oral function of completely edentulous adults. MATERIALS AND METHODS: Systematic literature searches were performed to identify records reporting on oral function in completely edentulous adults rehabilitated with implant-supported prostheses. Meta-analyses were performed on various outcomes including bite force, masticatory performance, muscle activity, mandibular movement/chewing pattern, and salivary flow. RESULTS: 5507 records were identified. Thirty studies qualified for data extraction and analysis. The kappa (ð) for the search and identification strategy ranged between 0.50 and 1.00. Meta-analysis was performed grouping the studies by outcomes and split by time points of 6-12 months, 12-36 months, and >36 months after implant therapy. The meta-analyses revealed a significant improvement in oral function of completely edentulous adults after rehabilitation with implant-supported prostheses at 6-12 months (Z = -4.895, p < .001; 95% CI: -0.703, -0.301; τ2 = .609; Q = 114.953, df = 17, p < .001; I2 = 85.2%), at 12-36 months (Z = -4.886, p < .001; 95% CI: -0.580, -0.248; τ2 = .908; Q = 280.611, df = 35, p < .001; I2 = 87.5%) and at more than 36 months (Z = -9.108, p < .001; 95% CI: -1.472, -0.951; τ2 = .019; Q = 7.918, df = 7, p = .340; I2 = 11.6%). The included studies demonstrated a low to moderate risk of bias. CONCLUSIONS: This systematic review concluded that the oral function of completely edentate adults significantly improved with implant-supported/retained prostheses, even when only one jaw received implant therapy. Therefore, implant therapy should be promoted for edentulous adults to alleviate the shortcomings of conventional complete removable dental prostheses.
Sujet(s)
Implants dentaires , Bouche édentée , Adulte , Humains , Prothèse dentaire implanto-portée , Force occlusale , Mandibule , Mastication , Bouche édentée/chirurgieRÉSUMÉ
PURPOSE: This study analyzed associations of cumulative learning, demographic characteristics, fluoride content, and toothbrush head size with the amount of toothpaste used by dental students. METHODS: Students in the third and fifth year of dental school were recruited. Each participant was asked to dispense three toothpastes (pediatric, regular fluoride, and high fluoride) on five toothbrushes (rotation-oscillation, sonic, manual pediatric, and two manual adult toothbrushes). The length and weight of the toothpaste dispensed were recorded. The data were evaluated by nonparametric correlation analysis (P < 0.05). RESULTS: Eighty-one students (third year = 42; fifth year = 39; mean age: 26.2 ± 5.3 years) participated in the study. More toothpaste was dispensed by third-year students than by fifth-year students (weight: P = 0.014; length: P = 0.037). Men dispensed more toothpaste than did women (weight: P < 0.001; length: P = 0.042). Participants with higher educational attainment dispensed less toothpaste (weight: P < 0.001; length: P < 0.001). The type of toothbrush was associated with the weight of toothpaste dispensed (P < 0.001). Toothbrush head size was inversely associated with the length of toothpaste dispensed (P < 0.001). CONCLUSION: The amount of toothpaste used by dental students was associated with cumulative learning, educational attainment, sex, and toothbrush head size but not with the fluoride content of the toothpaste.
Sujet(s)
Fluorures , Pâtes dentifrices , Mâle , Adulte , Humains , Enfant , Femelle , Jeune adulte , Étudiant dentisterie , Brossage dentaireRÉSUMÉ
OBJECTIVES: Maintaining the oral health of dependent older adults is challenging, with limited access to dental care and limited focus on preventive oral health programmes. This study aimed to evaluate the attitudes of General Dental Practitioners (GDPs), working in Switzerland, to caring for dependent older adults with a focus on the use of silver diamine fluoride (SDF) as a caries preventive agent and more widely on the provision of domiciliary dental care (DDC). METHODS: Seventeen GDPs working in Switzerland were interviewed. Each interview was semi-structured by a topic guide, digitally recorded, and transcribed. The transcribed data were analysed using a thematic analysis. RESULTS: Three major themes to the widespread use of SDF in this population were identified: lack of basic knowledge including indications for use; aesthetic concerns and product availability. Those who had knowledge about the product believed that using it in the treatment of frail older adults had advantages, especially in the preservation and/or prolongation of the life of teeth without invasive treatments. The biggest barrier was its availability. The GDPs identified three major barriers related to DDC provision: lack of infrastructure, poor financial rewards and safety concerns (patient and operator safety). Those who provided this service stated that they were doing it because of self-motivation, kindness, or as a role in community service. CONCLUSIONS: The potential use of SDF was viewed positively by the majority of the GDPs interviewed but confusion exists over its availability in Switzerland, and other barriers were identified to more widespread use in this patient group. The GDPs interviewed in this study reported that a lack of infrastructure and a low level of remuneration continue to be barriers to more of them undertaking DDC for dependent older adults.
Sujet(s)
Caries dentaires , Dentistes , Humains , Sujet âgé , Susceptibilité à la carie dentaire , Suisse , Rôle professionnel , Caries dentaires/prévention et contrôle , Fluorures topiques/usage thérapeutique , Soins dentaires , CariostatiquesRÉSUMÉ
OBJECTIVES: This review compared Computer-aided designand Computer-aided manufactured (CAD-CAM) and conventionally constructed removable complete dentures (CDs). DATA: Seventy-three studies reporting on CAD-CAM (milled/3D-printed) CDs were included in this review. The most recent literature search was performed on 15/03/2021. SOURCES: Two investigators searched electronic databases [PubMed (MEDLINE), Embase, CENTRAL], online search engines (Google) and research portals. Hand searches were performed to identify literature not available online. STUDY SELECTION: Studies on CAD-CAM CDs were included if they reported on trueness of fit, biocompatibility, mechanical, surface, chemical, color , microbiological properties, time-cost analysis, and clinical outcomes. Inter-investigator reliability was assessed using kappa scores. Meta-analyses were performed on the extracted data . RESULTS: The kappa score ranged between 0.897-1.000. Meta-analyses revealed that 3D-printed CDs were more true than conventional CDs (p = 0.039). Milled CDs had a higher flexural-strength than conventional and 3D-printed CDs (p < 0.0001). Milled CDs had a higher flexural-modulus than 3D-printed CDs (p < 0.0001). Milled CDs had a higher yield-strength than injection-molded (p = 0.004), and 3D-printed CDs (p = 0.001). Milled CDs had superior toughness (p < 0.0001) and surface roughness characteristics (p < 0.0001) than other CDs . Rapidly-prototyped CDs displayed poor color-stability compared to other CDs (p = 0.029). CAD-CAM CDs d displayed better retention than conventional CDs (p = 0.015). Conventional CDs had a higher strain at yield point than milled CDs (p < 0.0001), and had superior esthetics than 3D-printed (p < 0.0001). Fabrication of CAD-CAM CDs required less chairside time (p = 0.037) and lower overall costs (p < 0.0001) than conventional CDs. CONCLUSIONS: This systematic review concludes that CAD-CAM CDs offer a number of improved mechanical/surface properties and are not inferior when compared to conventional CDs. CLINICAL SIGNIFICANCE: CAD-CAM CDs should be considered for completely edentulous patients whenever possible, since this technique offers numerous advantages including better retention, mechanical and surface properties but most importantly preserves a digital record. This can be a great advantage for older adults with limited access to dental care.