Oral health in patients with type II diabetes and impaired glucose tolerance.

OBJECTIVE: To assess the influence of type II diabetes and impaired glucose tolerance on dental, periodontal, and oral mucosal tissues. RESEARCH DESIGN AND METHODS: We examined 11 subjects with type II diabetes, 32 with impaired glucose tolerance, and 43 control subjects from the oral physiology component of the Baltimore Longitudinal Study of Aging. At the time of the study, none of the participants was taking medication nor being treated for any medical problems other than diabetes. RESULTS: Only a few statistically significant dental and periodontal changes were apparent in the group with type II diabetes, and no oral mucosal differences existed between the diabetes and control groups. Dental, periodontal, and oral mucosal parameters in patients with impaired glucose tolerance were essentially indistinguishable from the other two groups. CONCLUSIONS: These findings suggest that among well-controlled individuals with type II diabetes and impaired glucose tolerance, few appreciable differences are evident in oral health.

Primary oral health care in black Americans: an assessment of current status and future needs.

To improve health for all in the United States by the year 2000, dental health needs must be considered a component of total health and primary care. The failure to address dental needs has reached a crisis level, particularly in the black and underserved communities throughout the nation. Data from several nationwide studies have shown that oral disease is greater in black Americans than their white counterparts. More severe periodontal disease patterns, untreated dental decay, and earlier tooth loss were observed. Key minority subgroups received less preventive care.

Oral health care in US nursing homes, 1995.

In 1993, nursing home care was a $70 billion industry. Since oral diseases are intertwined with declining health, it is important to achieve a better understanding of oral health care in nursing homes. The purpose of this paper is to present basic information regarding the nature of dental care from the 1995 US National Nursing Home Survey. Data include general availability of dental services, a description of types of dentists' and dental hygienists' services, and numbers of full-time equivalent dentists and dental hygienists. SUDAAN software was used to adjust for the complex, multistage sample design. Of the estimated 16,700 nursing homes in the contiguous US in 1995, between 14,000 and 15,000 offered some level of dental services. About 15,600 nursing homes provided assistance for oral hygiene, while some 7720 nursing homes had dental hygienists' services available. Approximately 60% of nursing homes either did not have services of dentists at all, or had them only on call or only off-site. Availability of dental services varied by characteristics of nursing homes. Examination of the nature of dental care raises questions about whether the intent of the Federal standards for dental care in Medicare and Medicaid are really being met. As more elderly remain dentate, and as the oral comorbidities of chronic diseases become more recognized, appropriate oral health services for individuals in long-term care settings likely will increase as public health issues.

Dental health and long-term care residents.

Many residents are only dimly aware of oral health problems, one of the most prevalent chronic conditions facing older adults. Poor oral function can result in diminished oral intake, discomfort, and may have a negative impact on quality of life.

Oral health status and related behaviours of U.S. nursing home residents, 1995.

SETTING: The 1995 U.S. National Nursing Home Survey. AIMS: A descriptive overview of reported oral health status and related behaviours for residents. DESIGN: Cross-sectional survey. SUBJECTS: 8,056 residents. INTERVENTION: Interviews by knowledgeable staff, examination of charts and/or personal knowledge. MAIN OUTCOME MEASURES: Information on the overall condition of oral health, edentulous status, presence/absence of dentures, difficulty chewing or biting, dental care received in past month, and method of payment for dental services in addition to personal characteristics and medical information. RESULTS: Fifteen percent of the residents were described as having excellent or very good oral health. Forty-one percent of the residents had difficulty chewing and biting. Almost one half of nursing home residents (47%) were totally edentulous. Twenty-six percent of residents had dental services paid for during the past month. Nursing home residents have multiple known barriers to oral health: ability to pay, extended periods of time without direct access to the dental care delivery system, and serious chronic medical conditions. CONCLUSIONS: There are serious deficiencies in achieving one of the US national health objectives: ensuring adequate oral health care for institutionalized individuals.

Sickle-cell anemia: a case report and literature review.

Sickle-cell disease is characterized by the pathophysiological features of chronic hemolytic anemia, vaso-occlusion resulting in ischemic tissue injury and painful episodes. The organs at greatest risk are the spleen, kidney and bone marrow, where oxygen tension is low and blood flow is diminished. However, disease may also present in the mandible. The oral manifestations and radiographic findings of a sickle cell patient with a left mandibular neuropathy, along with dental management guidelines are presented in the context of interdisciplinary care.

Sealant use and dental utilization in U.S. children.

The use of dental sealants has remained relatively low in the U.S. in comparison with other proven oral disease preventive therapies, and particularly among black children. Dental visits have also been consistently lower among black children. This paper describes the reported use of dental sealants and dental visits in U.S. children ages 6-17 using data from the 1989 National Health Interview Survey (NHIS). Family income and education interact with race in explaining the use of dental sealants and dental visits. Racial differences in sealant use and dental visits are more apparent in middle and upper socioeconomic levels, than lower socioeconomic level children. Overall, 15 percent of children ages 6-17 have dental sealants and 73 percent had a dental visit in the past twelve months. More white children whose parents had higher income levels and at least one year of undergraduate education (24 percent) had sealants than similar socioeconomic status (SES) black children (11 percent). Additionally, black children whose parents had a college education (68 percent) were less likely to have dental visits during the past 12 months than white children of similar SES (86 percent). These results provide an opportunity to evaluate factors and conditions that could form a basis of targeting programs to improve behaviors, attitudes, as well as access to preventive dental services.

Salivary gland function and glucose metabolic status.

To study the relationship between glucose metabolic status and salivary gland function in different-aged persons, subjects with diabetes mellitus (DM = 11), impaired glucose tolerance (IGT = 26), and controls (n = 26), aged 24 to 93, were examined in the oral physiology component of the Baltimore Longitudinal Study of Aging. All were generally healthy (except DM) and nonmedicated. The controls and subjects with IGT were classified using World Health Organization criteria, and diabetic status was assessed using Hb1Ac levels. Unstimulated and 2% citrate-stimulated parotid and submandibular salivary flow rates were collected, and subjective responses to questions about salivary hypofunction were evaluated. No statistically significant differences were observed between the three groups, nor between young and old subjects with altered glucose metabolism. These findings suggest that among well-controlled individuals with altered glucose metabolism, salivary gland function is not significantly impaired.

Parotid function and composition of parotid saliva among elderly edentulous African-American diabetics.

This study examined parotid salivary flow rate and composition in three groups of differently treated diabetics and a control group of non-diabetics. The study population was composed of edentulous African-Americans at least 65 years of age. Group A was the control, Group B insulin-dependent (Regular Iletin, U-100 qd.), Group C controlled by oral medication (Tolbutamide, 500 mg qd.), and Group D was diet controlled. All diabetic patients had serum glucose values under 250 mg/dl. Salivary flow rates, secretory IgA, electrolytes (Na+, Cl-, K+, Ca++) and total protein concentrations were evaluated. The results showed no significant differences between groups with respect to salivary flow rates, electrolytes and IgA concentrations. Additionally, all diabetic groups demonstrated a significantly lower salivary total protein concentration when compared to the controls. There appears to be no evident decrease in salivary flow rate in these three differently controlled diabetic groups compared with healthy non-diabetics.