Dental care utilization: a study of 50- to 75-year-olds in Southern Sweden

This study investigates dental care utilization in an adult population in Southern Sweden in relation to dental and social conditions, attitudes to costs, and perceived need to obtain dental services. The study was based on responses to a questionnaire sent in 1998 to a random sample, 1974 persons, aged 50-75 years. The response rate was 66%. A significantly higher probability of dental care utilization less than once a year was found for men, for those with few remaining teeth, and for those with removable dentures. A higher probability of dental care utilization less than once a year was found for those who stated perceived need to obtain dental care with no possibility because of the cost and for those who stated that the cost had influenced their attendance for dental care. The results showed that there were differences for sex and dental conditions in dental care utilization and that dental care utilization was related to attitudes towards costs of dental care.     

The first-choice standard of care for an edentulous mandible: A Delphi method survey of academic prosthodontists in the United States

BackgroundIn 2002 and 2009, two consensus statements—one from a symposium in Canada and one from England—were issued that recommended that the first-choice standard of care for an edentulous mandible should be the two implant–retained mandibular overdenture (IRMOD). The authors conducted a survey to determine if, in 2011, U.S. academic prosthodontic experts’ opinions were aligned with those in the two consensus statements.MethodsThe authors administered a Delphi method survey to an expert panel of 16 nationally representative academic prosthodontists to determine if there is consensus on the first-choice standard of care for an edentulous mandible between the IRMOD and a conventional mandibular complete denture (CD). Consensus agreement was defined as a 70 percent agreement level among the panelists.ResultsThe panel attained consensus favoring the IRMOD for nine of the 10 parameters assessed—retention, stability, speech, masticatory efficiency, comfort while eating soft foods and hard foods, confidence in intimate situations, satisfaction and self-esteem. The exception was esthetics for which only a majority (51–69 percent) favored the IRMOD.ConclusionsThe panelists reached consensus that they would recommend an IRMOD instead of a CD as the first-choice standard of care for patients who are healthy or have mild systemic disease, but not for patients with severe systemic disease.Clinical ImplicationsSurveyed academic prosthodontists recommend an IRMOD as the first choice standard of care when restoring an edentulous mandible of a healthy patient or a patient with mild systemic disease.     

Type 2 Diabetes and Edentulism as Chronic Co-Morbid Factors Affecting Indian Elderly: An Overview

In past 50 years, type 2 diabetes has emerged as one of the major public health problem. India leads the world with the largest number of diabetic patients and has a huge elderly population. The present article discusses the effect of diabetes and edentulism on the overall general health of elderly. The prevalence of type 2 diabetes and edentulism in Indian elderly and their inter-relationship has been discussed. Dentists must provide optimum oral care with special attention towards comprehensive periodontal management and oral hygiene awareness among diabetics to prevent tooth loss. Dental and medical professionals can improve patient management of the oral and overall effects of diabetes by implementing various awareness programs; organizing camps; distributing informative pamphlets and dietary counseling. Dentists can detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation and management.     

Aging in disguise: age, period and cohort effects in mobility and edentulousness over three decades

By corroborating cross-sectional with longitudinal analyses, this study illustrates how cohort effects can confound trends over age and time. Mobility (walking difficulties) and edentulousness (toothlessness) were studied from 1968 to 2002 in a nationally representative panel aged 18–75 (5 waves, n ≈ 5,000) and ages 77+ at later waves (2 waves, n ≈ 500). Three analyses were done: cross-sectional 10-year age group differences in 5 waves, time-lag differences between waves (shifts across time) for age groups, and within-cohort differences between waves for 10-year birth cohorts followed over time. Complementary age-period-cohort models using logistic regression analysis evaluated differences. Both mobility and edentulousness have earlier been shown to be strongly related to age cross-sectionally. For mobility, cross-sectional and longitudinal analyses showed large changes, whereas time-lag analysis indicated no or marginal changes. Both cross-sectional and longitudinal results showed an exponential curvilinear age dependency for mobility limitations, with limitations becoming more usual in older ages. In contrast, cross-sectional and time-lag analyses of edentulousness showed large differences, whereas longitudinal analysis indicated no or marginal changes. Rates of edentulousness became increasingly lower for successively later cohorts in a curvilinear fashion. These patterns demonstrate that age effects dominated mobility, whereas cohort effects dominated edentulousness. Age-period-cohort models confirmed these findings. The cohort effect of edentulousness implies that the cohorts’ movement through time gives a false impression of age and period effects in cross-sectional data.     

Edentulism risk indicators among Mexican elders 60-year-old and older

The objective of this study was to determine the prevalence of edentulism in Mexican elders aged 60 years and older, and the associated risk indicators. A cross-sectional study was undertaken in 139 elders living in either of two long-term care (LTC) facilities, or attending an adult day center (ADC) in Pachuca, Mexico. A subject was edentulous when natural teeth were completely absent, determined through a clinical examination. Risk indicators were collected using questionnaires. Analyses were performed using binary logistic regression in STATA 9.0. Mean age was 79.0 ± 9.8 years. Many subjects were women (69.1%). The prevalence of edentulism was 36.7%. In multivariate analysis, after adjusting for age and sex, the variables that were inversely associated (p < 0.05) with edentulism were living with a spouse (odds ratio = OR = 0.31), and lacking health insurance (OR = 0.70). Variables associated with higher risk of being edentate were lower educational attainment (OR = 1.61), having received radiation therapy (OR = 4.49), being a smoker (OR = 4.82), and having diabetes (OR = 2.94) or other chronic illnesses (OR = 1.82) (with hypertension approaching significance, p = 0.067). In this sample of Mexican elders, diverse variables were associated with edentulism, in particular smoking and past radiotherapy. Oral health programs within and outside LTC/ADC should take into account risk factors specific to the older population.     

Age,socioeconomic patterns and regional variations in grip strength among older adults (50+) in India: Evidence from WHO’s Study on Global Ageing and Adult Health (SAGE)

BackgroundMuscle strength, measured as grip strength is a potential marker of bodily function and sarcopaenia. Yet, not much is known about its patterns and correlates among older population in India. This study assesses the age and socioeconomic patterns and state variations in grip strength among older adults (50+) in India.MethodsA cross-sectional and nationally representative data from the first wave of WHO’s Study on global Ageing and Adult Health (SAGE) −2007 (n = 6262) was used. Multivariable linear regression analyses were used to understand the regional variations and association of socioeconomic status and general health with grip strength, adjusting for anthropometric and demographic confounders.ResultsSocioeconomic status has a significant association with grip strength. Moreover, the association between wealth quintile and grip strength was highly significant. Further, the socioeconomic differences in grip strength narrowed in older ages, especially among men, supporting the convergence of health inequality hypothesis. Notable differences were observed in grip strength across selected states of India. Poor self-rated health was negatively associated with grip strength. Edentulism in men was associated with reduced grip strength.ConclusionThis study has contributed to a better understanding of significant social and regional inequalities in grip strength among older population in India. State-specific and subgroup level interventions are important to improve the physical functioning of the growing older population in India.     

Association between missing tooth count and mortality: A systematic review

Purpose

The purpose of this review was to analyze existing literature on the relationship between tooth count and mortality by evaluating the findings in the context of methodological variations. We aimed at addressing the question of whether preserving natural teeth can impact mortality.

Treatment of Edentulism: Optimizing Outcomes with Tissue Management and Impression Techniques

Significant numbers of patients throughout the world seek treatment for edentulism. The trend toward tissue-integrated prostheses has been a monumental step in restoring edentulous patients to function; however, this treatment can be out of reach for those who fail to qualify or those who do not have sufficient resources to afford it. In these cases, conventional dentures remain an important primary course of treatment. Attention to detail when diagnosing, treatment planning, and performing treatment for these patients is still a prime consideration for the best possible outcome. In particular, many experienced denture wearers are afflicted with chronically inflamed denture-bearing mucosa. Clinicians must recognize the need for tissue conditioning, choices of impression materials, and accepted fabrication techniques that can have favorable outcomes when matched with patients who are philosophical and realistic in their expectations. The purpose of this article is to review impression philosophies, associated materials, and methods of tissue conditioning. Retention and stability of the denture bases can be augmented by the routine use of denture adhesive, and indications for use of denture adhesive will be discussed.     

Indigenous ball and socket implant supported mandibular overdenture: A case report

Edentulism is a major health concern of old age. Indigenous implant based over dentures offer a cost effective option for severely resorbed dental ridges. Here, we report rehabilitation of a resorbed mandibular arch with indigenous implant supported overdenture and maxillary arch with a conventional denture. Two ball and socket implants were placed bilaterally in the parasymphyseal area. Existing denture was relined to accommodate the ‘ball head’ of the implant in the interim period. Four months later, when patient was taken up for denture fabrication, the ‘socket part’ of the ball and socket implant was incorporated into the new denture base. The socket provided a fitting surface for the implant. Implant supported overdenture significantly increased the retention, support and stability of the lower denture. Further, it worked well with the upper conventional denture. The simple design and efficacy of indigenous implant based overdenture holds promising aspects in the treatment of edentulism.