The importance of communication in the construction of partial dentures.

Removable partial dentures (RPDs) are still a very important treatment modality in general dentistry to replace missing teeth. With the increase in popularity of implants, RPDs are sometimes seen as an 'old-fashioned' treatment option and if not carefully designed can be damaging to oral tissue and aesthetically less favourable. However, there is still a significantly large cohort of patients for whom RPDs are the best option for replacement of teeth either due to a failing dentition, inappropriate anatomy or financial considerations. This article explores the importance of effective three way communication with the patient, the laboratory and the dental nurse to support the provision of reliable and predictable prosthodontic outcomes.

The older dental patient - who cares?

People in the United Kingdom are living for longer and taking their natural dentitions with them into old age. If the dental profession as a whole is to be prepared to support the care of older people, a clear understanding of what it is to be old will be needed. But with much talk of this heavy metal generation having complex restorative needs, the technical aspects of care are being emphasised. This paper suggests that there may be more basic needs to be addressed.

Gingival recession related to removable partial dentures in older patients.

One hundred forty-six patients, living in the community and attending a general dental practice, were examined on two occasions separated by 3 years to determine relationships among removable partial dentures, their design, and gingival recession. This study confirmed the relationship between the presence of a partial denture and an increase of gingival recession, but was unable to demonstrate any predictable relationship to the lack of tooth support, the material used for the dentures, or covering the gingival margins with lingual plates. These design factors may be less important than the maintenance of good oral hygiene for the prevention of periodontal disease in patients wearing removable partial dentures.

The qualitative assessment of complete dentures produced by commercial dental laboratories.

Comprehensive criteria and simple methods of assessment have been developed for the evaluation of complete dentures supplied by commercial dental laboratories. One hundred laboratories in England and Wales were selected by random sampling. A single identical complete denture case was sent from general practice addresses to each of the selected laboratories and each of the laboratory stages evaluated according to specific criteria. This paper is concerned only with the evaluation of the finished dentures. Half of the cases were treated as NHS cases and half as 'private' cases. The private cases were further subdivided into those where details were left to the laboratory and those where detailed instructions were given for all stages of denture construction. Wide variations were found in both the quality and cost of complete denture laboratory work. Evaluation of some key features of finished dentures suggests that the quality of work was superior for the private cases in which detailed instructions were given to the laboratory. Even for the private (specified) cases, however, important faults were found in a number of cases.

Relationship of removable partial denture use to root caries in an older population.

The pattern and severity of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex, England, is reported. A total of 146 patients were examined to determine the relationship among removable partial dentures, their design, and root caries. Of those patients, 57% wore removable dentures and had a higher prevalence of exposed root surfaces and root caries, particularly on abutment teeth. In addition, root caries lesions on abutment surfaces were found to be larger and more active than those on nonabutment surfaces.

Salivary levels of mutans streptococci, lactobacilli, yeasts, and root caries prevalence in non-institutionalized elderly dental patients.

Root caries prevalence was recorded for a consecutive sample of dental patients (n = 146), aged over 55 yr and with at least 12 natural teeth. The mean root DFS score of the males (n = 49) was 6.34 +/- 4.55 and for the females (n = 97) 3.76 +/- 3.31 (P less than 0.001). The salivary levels of mutans streptococci, lactobacilli, and yeasts were determined in addition to salivary flow rate and buffering capacity. Subjects with greater than 1 root DFS had significantly higher salivary levels of mutans streptococci, lactobacilli, and yeasts. They also had fewer teeth and more exposed root surfaces. In step-wise multivariate analyses the factors significantly related to the root DFS score were the number of exposed root surfaces, number of teeth, sex and salivary yeast levels (R2 = 0.41). In the multivariate analyses salivary levels of mutans streptococci were not significantly related to any clinical measurement of root caries experience due to the greater strength of association between the root DFS score and salivary levels of yeasts. Subjects prescribed medicines with a reported xerostomic effect had significantly fewer active root lesions than those not prescribed such medicines and salivary levels of all microorganisms studied were significantly elevated in subjects prescribed medications containing sucrose.

Root caries in older people attending a general dental practice in East Sussex.

With increasing numbers of older people retaining their natural dentitions, dentists are becoming increasingly aware of the problem of dental caries occurring on exposed root surfaces--root caries. This study reports the prevalence of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex. A total of 146 non-institutionalised people, aged at least 55 years with at least 12 teeth, were examined. Most of the subjects (88.4%) had evidence of root caries, males and denture wearers having more lesions than females and non-denture wearers, respectively. Active coronal caries was present in only 11.6% of the subjects, whereas active (soft or leathery) root caries lesions were present in 31.5% of the subjects. The teeth and surfaces most commonly affected by root caries were found to be similar to those seen in previous epidemiological surveys. The majority of active root caries lesions were within 1 mm of the gingival margin, while inactive lesions tended to be greater than or equal to 1 mm from the gingival margin. Colour of root caries lesions was not diagnostic of caries activity. A more detailed method of recording root caries lesions is also described.

Associations between salivary levels of mutans streptococci, lactobacilli, yeasts and black-pigmented Bacteroides spp. and dental variables in elderly dental patients.

Multivariate step-wise regression analyses demonstrated that in a population of 146 elderly dental patients (mean age 69.8 yr) the salivary level of mutans streptococci was unrelated to the root DFS score, unlike the levels of lactobacilli and yeasts. Mutans streptococci were related to the wearing of partial dentures and the number of snacks eaten per day, while salivary lactobacillus levels were also related to the number of snacks eaten per day and to denture wearing, and negatively related to saliva buffering. Salivary yeast levels were also related to the wearing of partial dentures and the number of snacks eaten per day, and negatively related to salivary neuraminidase activity. The R2 values ranged from 0.21 to 0.28. Salivary level of black-pigmented Bacteroides spp. were related to maximum CPITN score, mean bleeding index and salivary trypsin-like activity (R2 was 0.08).