Oral health conditions of institutionalized older adults and associated factors / Condições de saúde bucal de idosos institucionalizados e seus fatores associados

INTRODUCTION: The growth of the Brazilian older adult population has influenced the increased demand for institutionalization for this public, which usually has poor oral health conditions such as edentulism. OBJECTIVE: To characterize the oral health conditions and verify the variables related to the edentulism of institutionalized older adults and verify the relation of the time of institutionalization with oral health. METHODS: It was a cross-sectional study conducted with 512 institutionalized older adults in which the sociodemographic profile, general health conditions, and oral health care and conditions were evaluated by clinical exams, consultations of medical records, and structured questionnaires. The data were analyzed in the Statistical Package for Social Sciences using the Pearson Chi-square and Fisher's Exact tests and a logistic regression model using a 95% confidence level. RESULTS: A high DMFT (29.4), high prevalence of complete edentulism (61.3%), high need for maxillary (73.6%), and mandibular oral rehabilitation (56.8%) were observed. Edentulism was associated with older age (p<0.001), lower schooling (p<0.001) and non-retirement (p=0.031). It was found that longer institutionalization time remained associated with edentulism even when adjusted by sociodemographic and general health variables (p=0.013). It was also associated with the absence of brushing (p=0.024) and a lower frequency of tooth, gum, and prosthesis brushing (p<0.001). CONCLUSION: It is suggested to establish oral health care routines within long-term institutions for the effective maintenance of oral health throughout the institutionalization time.

INTRODUÇÃO: O crescimento da população idosa brasileira tem influenciado no aumento da procura por institucionalização para esse público, que costuma apresentar precárias condições de saúde bucal como o edentulismo. OBJETIVO: Caracterizar as condições de saúde bucal e verificar as variáveis relacionadas ao edentulismo de idosos institucionalizados, além verificar a relação do tempo de institucionalização com a saúde bucal. MÉTODOS: Trata-se de um estudo transversal realizado com 512 idosos institucionalizados em que o perfil sociodemográfico, as condições gerais de saúde e os cuidados e condições de saúde bucal foram avaliados por meio de exames clínicos, consultas a prontuários e questionários estruturados. Os dados foram analisados no Statistical Package for the Social Sciences por meio dos testes Qui-quadrado de Pearson e Exato de Fisher e um modelo de regressão logística com nível de confiança de 95%. RESULTADOS: Observou-se alto CPOD (29,4), alta prevalência de edentulismo total (61,3%), alta necessidade de reabilitação oral maxilar (73,6%) e mandibular (56,8%). O edentulismo esteve associado a maior idade (p<0,001), menor escolaridade (p<0,001) e ausência de aposentadoria (p=0,031). Verificou-se que o maior tempo de institucionalização permaneceu associado ao edentulismo mesmo quando ajustado por variáveis sociodemográficas e de saúde geral (p=0,013). Além disso, também esteve associado à ausência de escovação (p=0,024) e menor frequência de escovação de dentes, gengivas e próteses (p<0,001). CONCLUSÃO: Sugere-se estabelecer rotinas de atenção à saúde bucal nas instituições de longa permanência para a manutenção efetiva da saúde bucal ao longo do tempo de institucionalização.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey

Abstract This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly: a cross-sectional study

Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly

Edentulismo, necessidade de prótese e autopercepção de saúde bucal entre idosos institucionalizados / Edentulism, need for dentures, and self-perception of oral health among institutionalized older people

RESUMO Objetivou-se descrever a condição de saúde bucal de idosos institucionalizados, com enfoque no edentulismo, na necessidade de prótese e na Autopercepção de Saúde Bucal (ASB), e explorar a associação com fatores individuais. Um estudo transversal foi realizado em Ponta Grossa, município do Sul do Brasil, com amostra de conveniência de idosos residentes em três Instituições de Longa Permanência para Idosos. Por meio de questionário estruturado, foram coletados dados sobre características demográficas, de saúde geral e bucal e acesso a serviços de saúde. No exame bucal, avaliou-se o Índice de dentes permanentes Cariados, Perdidos e Obturados (CPO-D), número de dentes presentes, uso e necessidade de prótese dentária e presença de lesões bucais. Foram avaliados 130 idosos, a maioria com mais de 80 anos (62,20%). O CPO-D médio foi de 30,62 (desvio-padrão 2,85), 62,31% dos idosos eram edêntulos, 41,54% usavam e 79,23% necessitavam de prótese dentária. As lesões bucais foram identificadas em 35,42% dos avaliados, e 64,86% dos idosos classificaram a ASB como boa. Conclui-se que a saúde bucal dos participantes foi considerada ruim, do ponto de vista clínico, levando em consideração a alta prevalência de edentulismo e a necessidade do uso de prótese dentária.

ABSTRACT The aim was to describe the oral health status of institutionalized older people, focusing on edentulism, need for dentures, and Self-Perception of Oral Health (SPOH), and to explore the association with individual factors. A cross-sectional study was carried out in Ponta Grossa, in the South of Brazil, with a convenience sample of older people living in three Long Stay Institutions for the Elderly. Using a structured questionnaire, data on demographic, general, and oral health characteristics and access to health services were collected. In the oral examination, the Index of Decayed, Missing and Filled permanent Teeth (DMFT), number of teeth present, use and need for dental prosthesis, and presence of oral lesions were evaluated. 130 older people were evaluated, most of them over 80 years old (62.20%). The mean DMFT was 30.62 (± 2.85), 62.31% of attendees were edentulous, 41.54% used, and 79.23% needed dental prosthesis. Oral lesions were identified in 35.42% of those evaluated and 64.86% of the participants classified their SPOH as good. It is concluded that the oral health of the participants was considered poor, from a clinical point of view, taking into account the high prevalence of edentulism and the need to use dental prosthesis.

Edentulism is associated with increased risk of all-cause mortality in adult men.

BACKGROUND: Prior reports of positive associations between edentulism and all-cause mortality have been limited by onetime assessments of edentulism and inadequate control of known confounding variables. The authors aimed to assess the association between edentulism and mortality using a longitudinal clinical oral health cohort. METHODS: The authors used data from the Department of Veterans Affairs Dental Longitudinal Study, an ongoing, closed-panel cohort study from 1968 through 2019 (N = 1,229). Dentition status was evaluated through triennial clinical examinations. Mortality was assessed via the National Death Registry. The authors used Cox regression models to estimate the association between edentulism and all-cause mortality after covariate adjustment. Furthermore, the authors calculated propensity scores and assessed hazard ratios (HRs) in a trimmed, matched, and inverse probability weighted sample. RESULTS: Participants who were edentulous (N = 112) had 1.24 (95% CI, 1.00 to 1.55) times the hazard of all-cause mortality compared with those who were nonedentulous, after adjustment with time-varying covariates. Use of propensity scores in the model resulted in slightly elevated HRs compared with the standard Cox model, regardless of propensity score method; adjusted HRs were 1.35 (95% CI, 1.01 to 1.80) after matching, 1.26 (95% CI, 1.00 to 1.59) after trimming, and 1.29 (95% CI, 1.18 to 1.42) after inverse probability weighting. CONCLUSIONS: Edentulism was associated with an increased risk of all-cause mortality in a cohort that captured incident edentulism. This association was consistent after multiple methods to account for confounding. PRACTICAL IMPLICATIONS: The findings of this study suggest that edentulism is associated with an increase in risk of mortality, after accounting for salient confounding variables using multiple approaches. Efforts to improve equitable access to tooth-preserving treatments are critical.

Evaluating edentulism and frailty in a group of elderly people treated at the dental clinic of Universidad San Martín de Porres in Lambayeque, Peru / Condiciones de edentulismo y fragilidad en un grupo de personas mayores que acudieron a la clínica odontológica de la Universidad San Martín de Porres de Lambayeque, Perú

Introduction: Dentistry should contribute to achieving healthy aging based on the identification of the well-being and oral health needs of the elderly. Objective: To evaluate the conditions of edentulism and frailty in a group of elderly people treated at the dental clinic of Universidad San Martín de Porres in Lambayeque, Peru, between the years 2016 and 2018. Material and Methods: An observational, descriptive, retrolective, and cross-sectional study was conducted. Two hundred and seven medical records that included an odontogram were randomly selected to identify cases of total or partial edentulism according to the Kennedy classification. The files were assessed with Fried's test to evaluate the conditions of frailty. The association between variables was estimated by means of a significance analysis using the Chi square test. Results: There was a statistically significant difference between edentulism in both jaws and conditions of frailty (p<0.05). An association of edentulism with physical inactivity and weakness was also demonstrated. Additionally, a statistically significant difference between degrees of edentulism was observed regarding poor diet (p<0.05). Conclusion: The absence of teeth in the elderly acts as a risk factor leading to negative changes in diet, weight, and physical activity. These changes may be associated with frailty, as masticatory insufficiency results in a poor diet and subsequent weakness.

Introducción: El aporte de la Odontología debe contribuir a lograr un envejecimiento saludable, basado en la identificación de las necesidades de bienestar y salud bucal de las personas mayores. Objetivo: Evaluar la condición de edentulismo y de fragilidad en un grupo de personas mayores atendidas en la Clínica Odontológica de la Universidad San Martín de Porres de Lambayeque, entre los años 2016 y 2018. Material y Métodos: Se diseñó un estudio observacional, descriptivo, retrolectivo y transversal, seleccionando de manera aleatoria 207 historias clínicas que incluyeron un odontograma para identificar casos de edentulismo total o parcial de acuerdo a la clasificación de Kennedy: mientras que para evaluar las condiciones de fragilidad fueron revisadas las fichas con el test de Fried. Diferencias entre variables fueron evaluadas con un análisis de significancia mediante la prueba Chi cuadrado. Resultado: Se mostró una diferencia estadísticamente significativa entre edentulismo en ambos maxilares y condiciones de fragilidad (p<0,05). Se evidenció además asociación de edentulismo con inactividad física y debilidad; observándose adicionalmente una diferencia estadísticamente significativa entre grados de edentulismo en relación a la mala alimentación (p<0,05). Conclusion: La ausencia de dientes en las personas mayores funge como un factor de riesgo que contribuye a cambios desfavorables en la dieta, el peso y la actividad física, mismos que se asocian con la fragilidad, donde la insuficiencia masticatoria puede conducir a una deficiente alimentación y la consecuente debilidad.

A higiene bucal de bebês edêntulos e sua influência na microbiota bucal: os profissionais de saúde devem preconizá-la? ­ revisão crítica / Oral hygiene in edentulous infants and its influence on oral microbiota: should the health professionals recommend it? ­ a critical review

Introdução: A indicação de higiene bucal em bebês edêntulos entre os profissionais de saúde ainda é controversa, sendo necessária a busca científica sobre esta indicação e a padronização da informação. Objetivo: Investigar criticamente as evidências relacionadas a indicação da higiene bucal para bebês edêntulos. Métodos: A busca de artigos foi realizada nas bases de dados PubMed, LILACS e Google Scholar, de modo a avaliar a seguinte pergunta: "A higienização da cavidade bucal de bebês edêntulos pode influenciar a microbiota bucal?". Uma busca em 8 livros de Odontopediatria também foi realizada. Resultados: Foram encontrados 317 artigos (167-PubMed, 146-Google Scholar e 4-LILACS). Não foram encontrados estudos primários que avaliaram o efeito da higiene bucal em bebês edêntulos na microbiota, impossibilitando a condução de revisão sistemática. Assim, para a revisão foram incluídos 6 estudos que investigaram micro-organismos na cavidade bucal de bebês edêntulos e o papel das imunoglobulinas salivares. Dentre os livros avaliados, somente 4 indicaram a higiene bucal em bebês edêntulos. Conclusão: Diante dos dados analisados, não existem estudos primários que avaliaram o efeito da higienização na microbiota bucal de bebês edêntulos. Torna-se relevante a condução de estudos clínicos para obtenção de evidências científicas sobre a indicação ou não da higienização da cavidade bucal de bebês edêntulos.

Introduction: The indication of oral hygiene in edentulous babies is still controversial among health professionals, being necessary the search of this recommendation and the standardization of information. Objective: To inves-tigate critically the evidence related to the indication of oral hygiene for edentulous babies. Methods: The search for articles was performed in the PubMed, LILACS and Google Scholar databases, in order to assess the following question: "Can oral cavity hygiene of edentulous babies influence oral microbiota?" A search in 8 books of Pediatric Dentistry was also performed. Results: 317 articles were found (167-PubMed, 146-Google Scholar and 4-LILACS). There were no primary studies that evalu-ated the effect of oral hygiene of edentulous infants on microbiota, which impair the conduction of a systematic review. Thus, it was included for this review six studies that investigated microorganisms in the oral cavity of edentulous infants and the role of salivary immunoglo- bulins. Among the textbooks evaluated, only 4 indicated the oral hygiene in edentulous infants. Conclusion:According to the data, there are no primary studies that assessed the effect of oral hygiene in the oral microbiota of edentulous babies. It is relevant to conduct clinical studies in order to obtain scientific evidence about the indication or no of the oral hygiene in edentulous babies

Preventing trauma during rigid oesophagoscopy in the edentulous patient: how I do it.

BACKGROUND: Rigid oesophagoscopy is a widely used therapeutic and diagnostic procedure. Smooth friction-free insertion of the rigid scope is important to prevent oral and oesophageal mucosal damage, as such damage can cause delays in oral intake or more serious complications such as perforation. Protection appliances such as gum guards are useful adjuncts to cushion the teeth in rigid oesophagoscopy; however, there are no specific adjuncts for the edentulous patient. METHODS: In order to investigate different adjuncts, the force required to pull a standard adult rigid oesophagoscope from a metal clamp whilst enclosed in dry gauze, wet gauze, a gum guard or sleek on gauze was recorded, and a prospective audit of post-procedural trauma was performed. RESULTS AND CONCLUSION: Less force was required to create movement of the scope against sleek on gauze, with a lower rate of oral trauma (8 per cent) compared to that reported in the literature. Sleek on gauze is recommended for the edentulous patient.

Can Denture Wearing Increase the Nutritional Status in Pre-Elderly and Elderly Patients?

Abstract Objective: To investigate the relationships among tooth loss, denture wearing, nutrition intake, and nutritional status. Material and Methods: This observational cohort study was conducted on 26 patients (≥ 45 years old) at the Faculty of Dentistry, Universitas Indonesia. Tooth loss was classified according to the Eichner Index. The Semi-quantitative Food Frequency Questionnaire was used to measure nutritional intake (kcal). Mini Nutritional Assessment Short Form (MNA-SF) and Handgrip Strength (HGS) assessments were employed to measure the nutritional status at baseline (before denture insertion), 1, 2, 3, 6, 9, and 12 months after denture use. Results: Significant differences in nutritional intake (p<0.05) between the Eichner B and C groups were noted at 3, 6, 9, and 12 months after using dentures. Significant increases in nutritional intake were noted after wearing the dentures (p<0.05) when compared with the baseline values. The nutritional status was considered normal in 65.4% of the patients at 12 months and 38.5% at baseline. Furthermore, the nutritional status 1, 2, 3, 6, 9, and 12 months after wearing denture was significantly improved compared with the baseline values (p<0.05). Significant differences in HGS (p<0.05) were observed between the Eichner B and C groups at 6, 9, and 12 months after using the denture. However, no significant differences in HGS were noted before and after wearing the denture (p<0.05). Conclusion: Denture wearing can improve the nutritional intake and status of pre-elderly and elderly patients.

Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient.

Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.

Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient

Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.

Factores asociados al desdentamiento en adolescentes / Factors associated with teeth loss in adolescents

RESUMEN Fundamento: la pérdida de dientes puede afectar a las personas de cualquier edad es más frecuente en el adulto mayor, aunque en la actualidad se ha incrementado el número de jóvenes que desde edades tempranas, presentan dientes perdidos. Objetivo: identificar los factores asociados al desdentamiento en los adolescentes del municipio Cifuentes. Métodos: se realizó un estudio epidemiológico descriptivo de corte transversal en el Municipio Cifuentes desde septiembre de 2015 hasta marzo de 2017. El universo lo constituyó la población con edades entre 12 y 18 años conformados por un total de 465 estudiantes, de ellos se seleccionaron 180 mediante un muestreo probabilístico por conglomerados estratificado bietápico. Resultados: el desdentamiento en los adolescentes tuvo una prevalencia de 17,2 % lo que coincidió con el número de pacientes que presentaban obturaciones, la higiene bucal regular estuvo presente en el 51,7 % mientras que en el 58,2 % de los adolescentes las pérdidas dentarias fueron asociadas a la caries dental. Conclusiones: dentro de los factores asociados a dicho fenómeno cabe destacar: la edad, la presencia de obturaciones y la higiene bucal. La principal causa de desdentamiento fue la caries dental.

ABSTRACT Background: the loss of teeth can affect people of any age and although this is more frequent in the elder, presently it has increased the number of young persons that from early ages, present lost teeth. Objective: to identify the associated factors to the tooth loss in teenagers of the municipality of Cifuentes. Methods: a descriptive epidemic study of traverse court was carried out in the Municipality of Cifuentes from September, 2015 to March, 2017.The universe of population was constituted for ages between 12 and 18 years conformed by a total of 465 students, of them 180 were selected by means of a probabilistic sampling by two-stage stratified conglomerates. Results: the loss of teeth in the adolescents was of 17.2 % same to the number of filled, the oral hygiene to regulate it was present in 51.7 % also in the 58.2 % the cause of teeth loss was a dental caries. Conclusions: among the factors associated to this phenomenon it is necessary to highlight: the age, the presence of filled and oral hygiene. The main cause of teeth loss was a dental cavity.

Quality of life related to complete denture.

Full edentulism is characterized by the complete loss of permanent teeth, resulting in aesthetic, structural and functional changes which can negatively impact quality of life, and which are minimized through rehabilitation with complete dentures. The aim of this study was to compare oral healthrelated quality of life in patients with complete original dentures three months after installation of new dentures and two years after fabrication of new complete removable dentures. In this longitudinal comparative study, 15 volunteers of both genders, aged 50 to 82 years, who sought treatment at the Department of Dentistry of the Federal University of Rio Grande do Norte, participated in the preparation of new dentures. The Brazilian version of the Oral Health Impact Profile for edentulous patients (OHIPEDENT) was used to evaluate quality of life. Data analysis was performed descriptively and with hypothesis testing using the Friedman and Wilcoxon tests with 5% significance level. In relation to the OHIPEDENT domains, there was a difference for chewing discomfort and inability to chew between baseline and two years. However, there was no difference between the evaluated periods in the areas of pain and orofacial muscle discomfort, psychological inability and social disability. Improvement indicators in patient quality of life were observed in the area of discomfort and inability to chew between baseline and 2 years.

O edentulismo completo caracterizase pela perda total dos dentes permanentes, resultando em alterações estéticas, estruturais e funcionais, podendo impactar negativamente na qualidade de vida, sendo minimizado através da reabilitação com a prótese dentária. O objetivo deste estudo foi comparar a qualidade de vida relacionada à saúde oral em pacientes com a prótese original completamaxilar e mandibular, três meses após instalação da nova prótese e dois anos depois da confecção da nova prótese total bimaxilar removível. Nesse estudo compara tivo longitudinal, participaram 15 voluntários, com faixa etária entre 50 e 82 anos, de ambos os sexos, que buscaram tratamento no Departamento de Odontologia da Universidade Federal do Rio Grande do Norte, para a confecção de novas próteses. Utilizouse a versão brasileira do Oral Health Impact Profile para pacientes edêntulos (OHIPEDENT) para avaliar a qualidade de vida. A análise dos dados foi realizada de forma descritiva e analítica com os testes de Friedman e Wilcoxon, com nível de significância de 5%.Em relação aos domínios do OHIPEDENT, verificouse diferença para desconforto e incapacidade mastigatória entre a avaliação inicial e após dois anos. Nos domínios Dor e desconforto orofacial, Incapacidade Psicológica e Incapa cidade Social, não ocorreram diferenças entre os períodos avaliados. Foram observados indicadores de melhora na qualidade de vida dos pacientes, no domínio desconforto e incapacidade mastigatória entre a avaliação e a 2 anos.

Resorption of the mandibular residual ridge: A micro-CT and histomorphometrical analysis.

OBJECTIVES: The aim of this study was to investigate whether the extent of mandibular resorption and gender is related to the bone turnover and microarchitecture of the edentulous mandible. PARTICIPANTS AND METHODS: A mandibular bone sample was obtained at canine position from 36 edentulous participants (50% women; mean age: 65 years) during dental implant surgery. All female participants were postmenopausal. Mandibular height, duration of edentulous state and resorption pattern (Cawood classification) were recorded. Microcomputed tomography was used to determine bone mineral density, bone volume fraction, trabecular connectivity density, trabecular number, trabecular thickness and trabecular separation. Histomorphometric analysis was used to assess bone turnover: osteoid area and surface were measured as a parameter for bone formation and osteoclast numbers were determined as a parameter for bone resorption. Correlations between micro-CT, histomorphometrical parameters and clinical data were analysed with correlation coefficients and parametric and non-parametric tests. RESULTS: Lower mandibular height was strongly associated with higher bone mineral density in trabecular bone. Women showed higher osteoclast numbers in trabecular bone than men. In trabecular bone of women, bone volume was significantly related to osteoclast numbers, osteoid surface and osteoid area. CONCLUSIONS: The higher trabecular bone mineral density found in the edentulous mandible could either indicate a restructuring process of the resorbed mandible or suggests that the inferior region of the mandible is more highly mineralised. In women, higher bone turnover is associated with lower bone volume, suggesting an effect of postmenopausal oestrogen deficiency on bone turnover in the edentulous mandible.

Quality of life related to complete denture

Full edentulism is characterized by the complete loss of permanent teeth, resulting in aesthetic, structural and functional changes which can negatively impact quality of life, and which are minimized through rehabilitation with complete dentures. The aim of this study was to compare oral healthrelated quality of life in patients with complete original dentures three months after installation of new dentures and two years after fabrication of new complete removable dentures. In this longitudinal comparative study, 15 volunteers of both genders, aged 50 to 82 years, who sought treatment at the Department of Dentistry of the Federal University of Rio Grande do Norte, participated in the preparation of new dentures. The Brazilian version of the Oral Health Impact Profile for edentulous patients (OHIPEDENT) was used to evaluate quality of life. Data analysis was performed descriptively and with hypothesis testing using the Friedman and Wilcoxon tests with 5% significance level. In relation to the OHIPEDENT domains, there was a difference for chewing discomfort and inability to chew between baseline and two years. However, there was no difference between the evaluated periods in the areas of pain and orofacial muscle discomfort, psychological inability and social disability. Improvement indicators in patient quality of life were observed in the area of discomfort and inability to chew between baseline and 2 years (AU)

O edentulismo completo caracterizase pela perda total dos dentes permanentes, resultando em alterações estéticas, estruturais e funcionais, podendo impactar negativamente na qualidade de vida, sendo minimizado através da reabilitação com a prótese dentária. O objetivo deste estudo foi comparar a qualidade de vida relacionada à saúde oral em pacientes com a prótese original completamaxilar e mandibular, três meses após instalação da nova prótese e dois anos depois da confecção da nova prótese total bimaxilar removível. Nesse estudo compara tivo longitudinal, participaram 15 voluntários, com faixa etária entre 50 e 82 anos, de ambos os sexos, que buscaram tratamento no Departamento de Odontologia da Universidade Federal do Rio Grande do Norte, para a confecção de novas próteses. Utilizouse a versão brasileira do Oral Health Impact Profile para pacientes edêntulos (OHIPEDENT) para avaliar a qualidade de vida. A análise dos dados foi realizada de forma descritiva e analítica com os testes de Friedman e Wilcoxon, com nível de significância de 5%.Em relação aos domínios do OHIPEDENT, verificouse diferença para desconforto e incapacidade mastigatória entre a avaliação inicial e após dois anos. Nos domínios Dor e desconforto orofacial, Incapacidade Psicológica e Incapa cidade Social, não ocorreram diferenças entre os períodos avaliados. Foram observados indicadores de melhora na qualidade de vida dos pacientes, no domínio desconforto e incapacidade mastigatória entre a avaliação e a 2 anos (AU)

Perda dentária e uso de prótese total removível: percepção entre usuários do serviço de saúde de Belo Horizonte / Tooth loss and use of complete dentures: perception among weares of the Belo Horizonte health service

Embora a prevalência da perda completa da dentição tenha diminuído nas últimas décadas, há uma proporção considerável de indivíduos desdentados em todo o mundo, associada às condições de vida e saúde da população. O edentulismo impacta na função bucal, podendo acarretar prejuízo de ordem nutricional, estética e psicológica, com reduções da autoestima e da integração social. A reabilitação com prótese dentária pode representar o retorno aos padrões socialmente aceitos além de contribuir com uma melhoria na qualidade de vida e auto estima das pessoas. Este estudo propôs-se a avaliar a percepção de usuários de próteses dentárias totais removíveis ofertadas pelo serviço público de saúde acerca da subjetividade que envolve o percurso desde a perda dentária até a reabilitação com prótese total removível e o processo de adaptação a esse tipo de reabilitação. Para isso foi utilizada uma abordagem qualitativa com participação de onze indivíduos que receberam suas próteses na Atenção Primária à Saúde, no serviço público de saúde de Belo Horizonte. A coleta do material foi realizada por meio de entrevistas individuais com os sujeitos a partir de três temas preestabelecidos: (i) perder os dentes, (ii) viver sem dentes e (iii) viver com dentes. O conteúdo das entrevistas foi gravado, e posteriormente transcrito para análise. A análise de conteúdo foi feita seguindo a orientação metodológica de Graneheim e Lundman. Os entrevistados relataram a dor como motivo para perda dentária, sendo a extração a solução definitiva para o alívio do problema. O conformismo e a resignação com a perda dos dentes refletem o entendimento de que o edentulismo é algo natural e inevitável. Viver sem os dentes foi sentido por muitos como "um baque" que afeta a aparência, a mastigação, a socialização e contribui para a seleção de alimento. A condição de edentulismo gerou sentimento de vergonha, envelhecimento e/ou desigualdade. A reabilitação com prótese foi vista como algo perene, que devolve a autoestima e favorece a mastigação, a socialização e o sentimento de completude. Embora o uso da prótese pôde ser sentido por muitos como um incômodo pela dor e problemas com a retenção e estabilidade, a resignação do sofrimento favorece a adaptação. O percurso da perda à reabilitação envolve sentimentos positivos e negativos modulados pela resignação e necessidade de resgatar a normalidade, tendo o contexto socioeconômico definido escolhas e modos de vivenciar problemas semelhantes pelas pessoas e influenciado nas crenças e comportamentos que resultaram no edentulismo.

Although the prevalence of complete tooth loss has declined in recent decades, there is a considerable proportion of edentulous individuals worldwide associated with the living and health conditions of the population. Edentulism impacts on oral function, which can lead to nutritional loss, aesthetic and psychological, with reductions in selfesteem and social integration. Complete dentures rehabilitation can represent a return to socially accepted standards and contribute to an improvement in people's quality of life and self-esteem. This study aimed to evaluate the perception of users of removable dentures complete offered by the public health service about the subjectivity that involves the course from tooth loss to rehabilitation with removable complete dentures and the process of adaptation to this type of rehabilitation to do so. To do so, a qualitative approach was used with eleven individuals who received their prosthesis through the public health service of Belo Horizonte. These were based on three preestablished topics: (i) losing teeth, (ii) living without teeth and (iii) living with dentures, where the study subjects were the users who obtained their total dentures offered by Primary Health Care in Belo Horizonte.The material was collected through individual interviews with the subjects. The content of the interviews was recorded and later transcribed for analysis. The content analysis was done following the methodological orientation of Graneheim and Lundman. Through this study it was concluded that in the majority of cases, the interviewees reported the pain as a reason for tooth loss, the extraction being the definitive solution for the relief of the problem. Conformism and resignation with the loss of teeth reflect the understanding that edentulism is something natural and inevitable. Living without teeth has been felt by many as a "thud" that affects appearance, chewing, socialization and contributes to food selection. The condition of edentulism generated a feeling of shame, aging and / or inequality. Rehabilitation with prosthesis was seen as something perennial, which returns selfesteem and favors chewing, socialization and feeling of completeness. Although the use of the prosthesis could be felt by many as a nuisance for pain and problems with retention and stability, resignation of suffering favors adaptation. The course from loss to rehabilitation involves positive and negative feelings modulated by the resignation and need to recover normality, the socioeconomic context defined choices and ways of experiencing similar problems by people and influenced in the beliefs and behaviors that resulted in edentulism.

Emergence Profile Index Implant Surgical Guide.

INTRODUCTION: This case series presents an innovative approach to fabricating an implant surgical guide to facilitate ideal implant placement. CASE SERIES: Three healthy, non-smoking patients with a partially edentulous ridge presented to a private practice. Informed consent for dental implant placement was attained from patients. Sequential three-dimensional (3D) surgical guides were fabricated before implant surgery using light-polymerizing material. These guides provided information to the surgeons on implant position in the bucco-lingual, mesio-distal, and apico-coronal directions. CONCLUSION: With assistance of the proposed surgical guide, ideal 3D implant placement can be achieved so that future peri-implant complications can be minimized.

Clinical aspects in the treatment planning for rehabilitation with overdenture and protocol-type prosthesis / Aspectos clínicos utilizados no planejamento de prótese overdenture e protocolo

Objective: The aim of this study was to criticaly review the published literature regarding the clinical aspects involved in the rehabilitation of edentulous patients using Branemark protocol and overdenture prostheses.Methods: An active search was conducted in the LILACS, MEDLINE, PubMed, and SciELO databases using the descriptors: "Coating for dentures" (Overlay Prosthesis and Overdenture) and "Implant-supported fixed dental prosthesis" (Protesis dental de suporte implantado, Dental prosthesis, and Implant Supported Prosthesis) in Portuguese, English, and Spanish between January 2000 and October 2014.Results: The following parameters should be considered when selecting between Branemark protocol and overdenture prostheses: bone support, lip support, lip-line, upper lip length, oral mucosa conditions and size, alveolar ridge contour, crown-bone ratio, interarch space, and speaking space. Overdenture rehabilitation can provide many benefits to patients, such as prosthetic retention, stability, comfort, and improved aesthetics.Conclusions: This study highlights the need for a thorough individualized treatment planning to ensure that fixed prostheses and overdentures have an excellent prognosis when used appropriately in suitable patients at the appropriate time.

Objetivo: Verificar por meio de revisão crítica da literatura os aspectos clínicos durante o planejamento de pacientes edêntulos frente à utilização de próteses tipo protocolo de Branemark e overdenture.Métodos: Busca ativa nas bases de dados LILACS, MEDLINE, PubMed e SciELO por meio dos descritores: "Revestimento de dentadura" (Prótese de Recobrimento e Overdenture) e "Prótese dentária fixada por implante" (Protesis dental de suporte implantado e Dental prosthesis, implant supported) entre janeiro de 2000 até outubro de 2014 nas línguas Portuguesa, Inglesa e Espanhola.Resultados: Deve-se levar em consideração para indicar as próteses overdentures e protocolo o suporte ósseo, suporte labial, linha do sorriso, comprimento do lábio superior, qualidade e quantidade da mucosa, contorno do rebordo alveolar, relação coroa/osso, espaço interarcos e zona fonética. A reabilitação com overdenture pode trazer muitos benefícios ao paciente, tais como retenção, estabilidade, conforto, e a estética.Conclusões: Evidencia-se a necessidade de um planejamento individualizado, para que se chegue a um correto plano de tratamento, no qual as próteses fixas e overdentures possam ter um excelente prognóstico, desde que utilizadas no momento apropriado e no paciente indicado.

Effects of a hydrogel patch on denture-related traumatic ulcers; an exploratory study.

PURPOSE: The aim of this exploratory study was to evaluate the effects of hydrogel patch wound dressing on healing time and pain level of denture-related lesions of the oral mucosa in edentulous individuals. MATERIALS AND METHODS: Twenty-three adults with newly fabricated complete sets of dentures who subsequently developed at least two ulcerative lesions related to their complete dentures were included in the study. For each participant, the smaller lesion (control lesion) was allocated to usual care, that is, adjustment of the denture's margins, whereas the larger lesion (test lesion) was assigned to receive usual care plus application of a hydrogel patch. In the latter, a patch was applied directly on the affected area three times within the first 24 hours, followed by application of three additional patches, namely one during each of the following 3 days. Participants were monitored until complete healing of all ulcers. The primary outcome measures were changes since baseline in each lesion's greatest dimension at days 1 and 7, as well as improvement in ulcer-related pain experienced. RESULTS: Participants were on average about 70 years old, about half were women, and just over 40% had type 2 diabetes. Lesions treated with the hydrogel patch extended between 4.3 and 10.2 mm (mean 7.1 mm) in their greatest dimension, and the smaller lesions receiving usual care were initially 4 mm on average, ranging from 2.0 to 7.0 mm. The hydrogel patch lesions attained 25% to 75% reductions in their greatest lesion extent from baseline to days 1 and 7, respectively, compared to 10% and just over 50% reduction in the lesions that received usual care. Healing rates were similar in patients with and without diabetes. The participants reported significant improvement in pain level 1 day following treatment initiation for 30% of the control lesions, compared to 65% of the lesions treated with the hydrogel patch. CONCLUSIONS: The results of this exploratory study suggest that application of hydrogel patches may represent a novel, effective treatment for accelerating the healing process and pain reduction in mucosal lesions associated with complete dentures also in people with type 2 diabetes; however, larger studies need to confirm these findings.

Influencia de la rehabilitación protésica en la calidad de vida de los pacientes / Influence of prosthetic rehabilitation in the patients' life quality

Se realizó un estudio descriptivo para evaluar la influencia de la rehabilitación protésica en la calidad de vida de los pacientes desdentados totales tratados en las clínicas estomatológicas docentes "Ismael Clark Mascaró" y "La Vigía" en Camagüey, desde septiembre del 2009 a septiembre del 2013. El universo estuvo comprendido por 254 pacientes desdentados totales rehabilitados y una muestra de 43, a través de un muestreo probabilístico aleatorio. Se obtuvo un predominio del grupo de 50-69 años y el sexo femenino. Al determinar los problemas mecánicos se apreció que los flancos sobreextendidos, seguido de las inserciones frénicas sin liberar y la presencia de puntos prematuros de contacto, fueron las principales dificultades encontradas en los pacientes portadores de prótesis totales. La rehabilitación influyó en la calidad de vida de estos pacientes.

It was carried out a descriptive study with the objective to evaluate the influence of prosthetic rehabilitation in total toothless patients life quality treated in the teaching stomatological clinics ¨Ismael Clark Mascaró" and "La Vigía" in Camagüey, from September 2009 to September 2013, with a universe of study composed by 254 total toothless patients who were rehabilitated. The sample was of 43, through a random probabilistic sampling. There was a predominance of the female group aged from 50-69 years old, followed by the female group aged 70. While determining the mechanical problems it was appreciated that the flanks overextended, followed of phrenic insertions without being sustained and the presence of premature points of contact, and were the main difficulties found in the patient's carrier of total prostheses. Prosthetic rehabilitation influenced in the patients´ quality life.