Tooth loss in the elderly and its association with nutritional status, socio-economic and lifestyle factors

OBJECTIVE: Tooth loss impacts on general health and is a risk factor for malnutrition, disability, loss of self-sufficiency, and deterioration in quality of life. The present study was carried out to evaluate the prevalence of edentulism and its association with social and lifestyle factors in a population of elderly Italians. MATERIAL AND METHODS: Dental, social, and disease conditions were evaluated in a large community-based cohort (3054) of elderly subjects (> or =65 years) of both sexes in northern Italy. Logistic regression analyses with stepwise forward selection were performed to estimate the independent contribution of nutritional, socio-economic, and lifestyle variables to dental status. Adjusted ORs and 95% CI were estimated for variables significantly associated with edentulism. RESULTS: The prevalence of edentulism was about 44.0%. It was more pronounced in females and it was twice as prevalent in the 90+ years age group. Among edentulous subjects, 17.5% wore no prostheses. Difficulties in chewing and in swallowing were reported by 47.6% and 13.7% of the subjects, respectively. Multivariate analysis indicates that edentulism was associated with age in both sexes. For women, independently associated risk factors were: years since menopause >23 (OR = 1.81; 95% CI: 1.37-2.40), number of children >3 (OR = 1.95; 95% CI: 1.36-2.80), and living alone (OR = 1.47; 95% CI: 1.15-1.88). For men, these were serum albumin <40 g/l (OR = 1.79; 95% CI: 1.22-2.63), current smoking (OR = 4.01; 95% CI: 2.59-6.20), and former smoking (OR = 3.42; 95% CI: 2.42-4.82). CONCLUSIONS: The prevalence of edentulism among the elderly Italian population studied was at the high end among Western countries, and higher in women than in men. In women, tooth loss correlated with aging, female events (pregnancies, menopausal status), and living alone. In men, aging and smoking are important determinants of edentulism, which is associated with the risk condition of hypoalbuminemia. Difficulty in chewing was associated with dentition type. In our study, the high prevalence of edentulous subjects without prostheses suggests a need for educational and social measures to improve patients' attitudes to dental care and to encourage the use of prostheses among the elderly.     

Dental status of the Iranian elderly: A systematic review and meta‐analysis

Tooth loss is an important health dilemma. The aim of the present study was to perform a systematic review and meta‐analysis of dental status and edentulism in the elderly residing in Iran. An electronic search of the literature was carried out on Farsi and English databases using the following keywords: edentulism, dental caries, elderly, oral and dental health, edentulous, geriatric, caries, dentate, Iran, and prevalence. Articles that met the eligibility criteria according to the STROBE (Strengthening the Reporting of Observational Studies In Epidemiology) checklist were selected and entered into the meta‐analysis. Data were analyzed using Stata 13.1 software, and the metan and metareg packages for used for the meta‐regression and meta‐analysis. Of the 172 articles retrieved, 154 were used after eliminating the duplicates, and their full texts were read. Of the 4574 participants evaluated in 13 studies, 2227 (48.7%) were completely edentulous (95% confidence interval [CI]: .49‐.49). Of the 4423 participants evaluated in 12 studies, 2286 (51.7%) were dentate (95% CI: .52‐.52). The mean number of remaining teeth was 5.73 (95% CI: 5.73‐5.73) in six studies conducted on 2782 participants. Approximately 50% of the elderly in Iran are completely edentulous. Efforts should be made to improve dental care instruction, provision of dental care services in the public sector, and dental insurance coverage to promote the dental status of elderly Iranians.     

Tooth loss in the elderly and its association with nutritional status,socio-economic and lifestyle factors

Objective. Tooth loss impacts on general health and is a risk factor for malnutrition, disability, loss of self-sufficiency, and deterioration in quality of life. The present study was carried out to evaluate the prevalence of edentulism and its association with social and lifestyle factors in a population of elderly Italians. Material and Methods. Dental, social, and disease conditions were evaluated in a large community-based cohort (3054) of elderly subjects (≥65 years) of both sexes in northern Italy. Logistic regression analyses with stepwise forward selection were performed to estimate the independent contribution of nutritional, socio-economic, and lifestyle variables to dental status. Adjusted ORs and 95% CI were estimated for variables significantly associated with edentulism. Results. The prevalence of edentulism was about 44.0%. It was more pronounced in females and it was twice as prevalent in the 90+ years age group. Among edentulous subjects, 17.5% wore no prostheses. Difficulties in chewing and in swallowing were reported by 47.6% and 13.7% of the subjects, respectively. Multivariate analysis indicates that edentulism was associated with age in both sexes. For women, independently associated risk factors were: years since menopause >23 (OR = 1.81; 95% CI: 1.37–2.40), number of children >3 (OR = 1.95; 95% CI: 1.36–2.80), and living alone (OR = 1.47; 95% CI: 1.15–1.88). For men, these were serum albumin <40 g/l (OR = 1.79; 95% CI: 1.22–2.63), current smoking (OR = 4.01; 95% CI: 2.59–6.20), and former smoking (OR = 3.42; 95% CI: 2.42–4.82). Conclusions. The prevalence of edentulism among the elderly Italian population studied was at the high end among Western countries, and higher in women than in men. In women, tooth loss correlated with aging, female events (pregnancies, menopausal status), and living alone. In men, aging and smoking are important determinants of edentulism, which is associated with the risk condition of hypoalbuminemia. Difficulty in chewing was associated with dentition type. In our study, the high prevalence of edentulous subjects without prostheses suggests a need for educational and social measures to improve patients’ attitudes to dental care and to encourage the use of prostheses among the elderly.     

Factors related to the resting tongue position among partially and completely edentulous subjects

The prevalence of abnormal (retracted) position of the tongue at rest was examined in subjects with varying number of natural lower teeth. The aim of the study was to explore the relationship between tongue retraction and state of dentition and to identify potentially related parameters. The resting tongue positions were recorded in subjects partially edentulous in the lower jaw (n = 164) and compared with those met in dentate (n = 57) and completely edentulous participants (n = 84). Potentially related parameters, such as age, sex, duration of edentulism, palate vault and signs of temporomandibular disorders were also recorded. Tongue retraction was observed in a small percentage (12.3%) of the dentate, almost half (45.7%) of the partially edentulous and in the majority (67.8%) of the completely edentulous participants. The number of natural lower teeth correlated with the resting tongue position in the partially edentulous group. The tongue position at rest was also found weakly related to signs of temporomandibular disorders in the dentate group and to the sex and duration of edentulism in the partially edentulous group. It was concluded that the abnormal positioning of the resting tongue is increasingly observed with decreasing number of natural teeth, possibly in accordance with the morphological and functional alterations that result from teeth loss. The presence of a retracted tongue affects the complete denture construction; however, its effect on denture function remains questionable.     

Correlation of gonial angle size with cortical thickness, height of the mandibular residual body, and duration of edentulism

STATEMENT OF PROBLEM: Previous reports on widening of the gonial angle in edentulous patients are conflicting. Aside from age and loss of teeth, other factors may influence change in gonial angle. PURPOSE: This study evaluated gonial angles from panoramic radiographs of young and older dentate subjects and elderly edentulous subjects and investigated the relationship of gonial angle size to gender, age group, cortical thickness at the gonial angle, height of the mandibular residual body, and edentulous period in elderly edentulous subjects. MATERIAL AND METHODS: A total of 356 panoramic radiographs of 3 groups of subjects were evaluated: the young dentate group, 131 subjects (mean age 27 years); the older dentate group, 97 subjects older than age 52 (mean age 64 years); and the elderly edentulous group, 128 subjects aged 76, 81, or 86 (mean age 80 years). The gonial angle, cortical thickness at gonial angle, and height of mandibular residual body were measured from panoramic radiographs made with the same radiographic equipment and selected according to criteria. A structured questionnaire was used to determine the history of edentulism. Paired and unpaired 2-tailed t tests served to test the difference in gonial angle measurements, and a linear regression was performed to study correlations (alpha=.05). RESULTS: Difference in size of the gonial angle was found between dentate men and women (P<.05 in the young and P<.001 in the older dentate group), but not between elderly edentulous men and women. The elderly edentulous subjects had significantly larger gonial angles (128.4 degrees +/- 6.6) than did the young (122.4 degrees +/- 6.6, P<.001) and older dentate subjects (122.8 degrees +/- 6.6, P<.001). The angle size was negatively related to cortical thickness at the gonial angle only among 76-year-old edentulous women (P<.01), and was associated with average height of the mandibular residual body in the edentulous men and women (P<.01). No association existed between angle size and duration of edentulism. No differences were significant in any test of intraexaminer error. CONCLUSION: In this study, elderly edentulous subjects had larger gonial angles than did dentate subjects. The angle size was correlated with low height of the mandibular residual body and with its cortical thickness in edentulous women.     

Association of edentulousness with systemic factors in elderly people living at home

OBJECTIVE: To examine the association of edentulousness with systemic factors: age, gender, tobacco-smoking, alcohol intake, body mass index, functioning in daily living, cortical thickness at the mandibular angle, and systemic diseases: bone-fracture (an indicator for osteoporosis), diabetes, thyroid disease, hyperparathyroidism, asthma, heart failure, hypertension. METHODS: The study population comprised 293 elderly subjects, 124 (42%) edentulous and 169 (58%) dentate. The data from clinical and radiographic examinations and structured interviews were analyzed by multiple logistic regression. RESULTS: When edentulousness in both the mandible and the maxilla was considered, history of bone fracture and tobacco-smoking were significantly related to complete edentulousness with odds ratios (OR) of 2.51 (95% CI: 1.47-4.28) and 2.42 (95% CI: 1.32-4.43) respectively, associations independent of age and gender. A similar association was found for the edentulous mandible. In the elderly subjects with an edentulous maxilla, besides the significant factors of history of bone fracture and tobacco-smoking, asthma was also associated with edentulousness at an odds ratio of 10.81 (95% CI: 1.38-84.66), oldest subjects most often being edentulous (OR: 2.23, 95% CI: 1.13-4.39). Diabetes was not related to edentulousness either in the mandible or in the maxilla. CONCLUSIONS: The finding of associations of history of bone fracture, tobacco-smoking, and asthma with edentulousness emphasizes the association of systemic conditions with edentulousness. Advanced age was related to an edentulous maxilla. The relationship between asthma and total tooth loss in the maxilla might suggest a local oral effect of medications used by asthmatic patients.     

Periodontitis and coronary artery calcification: the Atherosclerosis Risk in Communities (ARIC) study

BACKGROUND: Periodontitis has been linked to coronary heart disease (CHD) risk, possibly through providing a systemic inflammatory burden. Few studies have evaluated periodontitis and subclinical measures of atherosclerosis. Coronary artery calcification (CAC) is an emerging marker for atherosclerosis, and past studies suggest that it predicts incident CHD in asymptomatic populations. METHODS: In 1996-1998, dental examinations were performed on 6,931 participants in the Atherosclerosis Risk in Communities (ARIC) cohort. Extent of periodontitis was measured by the percent of sites with attachment level (AL) > or = 3 mm. In 1999-2000, CAC was measured by cardiac gated mechanical or helical computed tomography in 269 dental examinees and edentulous subjects from the Minnesota and North Carolina field centers of ARIC who were free of clinically recognized CHD. A traditional Agatston score for CAC was calculated. RESULTS: Compared to subjects with no or mild periodontitis (<10% of sites with AL > or = 3 mm), subjects with moderate or severe periodontitis (> or = 10% of sites with AL > or = 3 mm) were more likely to have CAC > or = 100, but this difference was not statistically significant (odds ratio [OR]: 1.78; 95% confidence interval [CI]: 0.65 to 4.86). This association was partially but not completely attenuated when adjusted for demographic factors and traditional CHD risk factors (OR: 1.51; 95% CI: 0.54 to 4.23). CONCLUSIONS: These results suggest that periodontitis is not strongly associated with CAC. This study offers some reference for the magnitude of the association between CAC and periodontitis and information regarding the minimal power necessary for future studies.     

Stimulated parotid gland flow rates in healthy, elderly dentulous and edentulous individuals

The use of dentures has been associated with increased stimulated parotid salivary flow rates (SPFR). A comparison of SPFRs was made between dentulous subjects having 20+ teeth (n = 190) and edentulous individuals (n = 67). Two different populations were selected, a white group from the Baltimore Longitudinal Study of Aging and an African-American group from the Washington Village Medical Center in Baltimore. Each group was healthy and unmedicated and had a mean age of 70.2 years. SPFR was determined with a Carlson-Crittenden cup and 2% citrate for stimulation. The edentulous subjects did not wear their dentures during salivary collection. The results indicated a significantly lower SPFR in dentate individuals compared with edentulous subjects (p < 0.01). Dentulous men also had a lower SPFR than edentulous men (p < 0.04). In addition, a pre- and postsurgical evaluation of 10 individuals who underwent full mouth tooth extractions revealed no differences in SPFR. These results suggest that edentulism per se does not have a deleterious effect on stimulated parotid salivary flow rates.     

Comparison of masticatory efficacy among complete denture wearers with two adhesives and dentate individuals: A randomized,crossover, double-blind clinical trial

Statement of problem

The masticatory efficacy between dentate and edentulous individuals with and without the use of dental adhesives has been little studied. A comparative study of the addition of various agents of synthetic adhesion (vinyl methyl ether versus polyvinyl acetate) to these adhesives is needed.

Dental caries experience: a two-generation study

The life-course framework stresses the importance of social, psychosocial, and biological factors in early life on the development of later disease. From this perspective, the association between edentulousness of mothers and their children's caries risk has not been studied. Therefore, a sample of 6303 mother-child pairs was randomly selected in Quebec (Canada). Mothers (6039 dentate and 264 edentulous) completed a self-administered questionnaire, and their children, aged 5 to 9 years, were clinically examined. Bivariate analyses and multiple logistic regressions showed that edentulous mothers' children are more likely to experience caries on both primary [OR=1.7 (1.3-2.3)] and permanent [OR=1.4 (1.0-2.0)] dentitions when compared with dentate mothers' children. These results are independent of socio-economic status, age, gender, and children's oral-health-related behaviors. Our study is the first to show that edentulous mothers' children constitute a group at risk of caries. It also highlights the need for a better understanding of the mother-child transmission of risk.     

Edentulousness and its rehabilitation over a 10-year period in a Finnish urban area

Abstract In 1977–78, a baseline study group of 449 Finnish adults aged 30 years and over was examined in an urban area with a very high supply of dental services. The follow–up study in 1988 represents longitudinal data on 297 of these adults. In 1989 a new sample of persons aged 30–39 years was also obtained to provide cross-sectional information comparable to that of the corresponding age group in the 1977–78 survey. At baseline in 1977–78, the prevalence of total tooth loss was 19.4% for adults aged 30 years and over. The corresponding figures for maxillary and mandibular edentulousness alone were 16.7% and 0.4% respectively. Ninety-four percent of totally edentulous and 89.6% of single-arch edentulous subjects were prosthetically rehabilitated. In the follow-up study, 1.1% of the originally dentate women and 6.7% of men had lost the rest of their teeth. For the new totally edentulous subjects the mean number of teeth lost was 5.7 (s 3.45), most of which were incisors. In the follow–up study, 89% of the new edentulous subjects had already been edentulous in the maxilla at baseline. Among 30–39-year-olds the proportions of upper-arch and totally edentulous subjects in 1977–78/1989 were 6.7%/0.8% and 2.2%/O.S% respectively (p=0.024 for the difference between the time points). In the light of the repeated cross-sectional study, we can conclude that edentulism is very uncommon in the 30–39-year age group in this urban area.     

Trends and prognoses of dental status in the Swedish population: analysis based on interviews in 1975 to 1997 by Statistics Sweden

The aims of this study were to describe changes in dental status over the 22-year period from 1975 to 1997, and to make a prognosis of dental status based on these data for the years 2005 and 2015. The study is based on regular investigations of the living conditions performed by Statistics Sweden of samples varying between 11,582 and 14,964 participants and a response rate from 78% to 86%. The questions of the interview used in this study were focused on dental status and utilization of dental services. The prevalence of edentulism in the age group 25-74 years decreased from 19% in 1975 to 3% in 1996/97. The proportion of dentate persons increased from 75% in 1975 to 97% in 1996/97 in age group 45-64 years with similar trends in the other age groups. In 1996/97, 2.1% of the whole sample (16-84 years) reported that they had received implant-supported restorations. The rate was higher among the elderly and the edentulous subjects. The great regional differences in dental status found in the first part of the observation period remained only in the oldest age group in 1996/97. The prognosis predicts that 95% of the subjects in age group 65-74 years and 90% in age group 75-84 years will be dentate in the year 2015. The substantial increase of dentate subjects among the elderly that has occurred during the past few decades and its expected continuation in the coming years implies a great change in need and demand for dental care services.     

Trends and prognoses of dental status in the Swedish population: analysis based on interviews in 1975 to 1997 by Statistics Sweden

The aims of this study were to describe changes in dental status over the 22-year period from 1975 to 1997, and to make a prognosis of dental status based on these data for the years 2005 and 2015. The study is based on regular investigations of the living conditions performed by Statistics Sweden of samples varying between 11,582 and 14,964 participants and a response rate from 78% to 86%. The questions of the interview used in this study were focused on dental status and utilization of dental services. The prevalence of edentulism in the age group 25-74 years decreased from 19% in 1975 to 3% in 1996/97. The proportion of dentate persons increased from 75% in 1975 to 97% in 1996/97 in age group 45-64 years with similar trends in the other age groups. In 1996/97, 2.1% of the whole sample (16-84 years) reported that they had received implant-supported restorations. The rate was higher among the elderly and the edentulous subjects. The great regional differences in dental status found in the first part of the observation period remained only in the oldest age group in 1996/97. The prognosis predicts that 95% of the subjects in age group 65-74 years and 90% in age group 75-84 years will be dentate in the year 2015. The substantial increase of dentate subjects among the elderly that has occurred during the past few decades and its expected continuation in the coming years implies a great change in need and demand for dental care services.     

Maxillary sinus septa: a 3-dimensional computerized tomographic scan analysis

PURPOSE: The purpose of this study was to determine the prevalence, size, location, and morphology of maxillary sinus septa in dentate, partially dentate, and edentulous maxillae. MATERIALS AND METHODS: Data from 312 sinuses were analyzed from reformatted computerized tomograms utilizing SIM/Plant software. The sample consisted of 156 patients (106 women and 50 men, with ages ranging between 24 and 86 years and a mean age of 55.4 years) who were being treatment-planned to receive implant-supported restorations. RESULTS: A total of 75 septa were found in 312 maxillary sinuses (24%), which corresponded to 32.7% of the patients (51 of 156). Completely edentulous patients presented with 33.3% of the total septa, while 66.7% of the septa were identified in partially edentulous patients. Analysis of the anatomic location of the septa within the sinus revealed that 18 (24.0%) septa were located in the anterior region, 31 (41.0%) were in the middle, and 26 (35.0%) were in the posterior region. Measurements of height of the septa varied among different areas. The lateral area ranged from 0 to 15.7 mm (with a mean of 3.54 +/- 3.35 mm), the middle area ranged from 0 to 17.3 mm (with a mean of 5.89 +/- 3.14 mm), and the medial area ranged from 0 to 20.6 mm (with a mean of 7.59 +/- 3.76 mm). A total of 20 septa (26.7%) were located in the immediate apical region of teeth. The remaining 55 septa (73.3%) were related to edentulous areas. DISCUSSION: Septa may arise in any of the 3 regions of the maxillary sinus irrespective of the degree of dentulism or edentulism present. CONCLUSION: To avoid unnecessary complications during sinus augmentation procedures, adequate and timely identification of the anatomic structures inherent to the maxillary sinus are required.     

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

BackgroundPrior 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.MethodsThe 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.ResultsParticipants 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.ConclusionsEdentulism 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 ImplicationsThe 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.     

Association Between Edentulism and Angina Pectoris in Mexican Adults Aged 35 Years and Older: A Multivariate Analysis of a Population‐Based Survey

Background: The possible association between oral infection and chronic inflammation and cardiovascular disease risk has been studied intensively. The present study is designed to determine the strength of association between edentulism and angina pectoris in Mexican adults aged 35 years and older. Methods: Using the tools and sampling strategies of the World Health Survey of the World Health Organization, cross‐sectional data were collected in Mexico in the National Performance Assessment Survey (probabilistic, multistage, and cluster sampling). Dental information was available for 20 of the 32 states of Mexico. Angina and edentulism are self‐reported in this study. Statistical analysis was performed using binary logistic regression adjusting for complex samples. Results: A total of 13,966 participants, representing a population of 29,853,607 individuals, were included. Of the complete study population, 3,052,263 (10.2%) were completely toothless, and 673,810 (2.3%) were diagnosed with angina pectoris. After adjusting for smoking, alcohol consumption, diabetes, body mass index, and sex, the effect of edentulism on angina was modified by age (interaction), being more marked in the younger age group (odds ratio [OR] = exp^2.5597 =12.93) than in the older individuals surveyed (OR = exp^{2.5597 + (?0.0334)} =12.51). Additionally, low physical activity (OR = 1.51; 95% confidence interval [CI] = 1.03 to 2.22) and higher socioeconomic status (OR = 1.37; 95% CI = 1.00 to 1.90) were more likely to be associated with angina pectoris. Conclusions: Overall, the results of this study, conducted in a representative sample of Mexican adults, suggest that an association exists between edentulism and angina pectoris. Additional studies are necessary to elucidate the underlying mechanism for this association.     

An Index of Chewing Ability

This study was carried out to develop and test an index of chewing ability suitable for epidemiologic surveys. Existing data on older adults living independently in East York, Ontario, were reanalyzed and the index was developed using techniques of scalogram analysis. Individuals were scored from 0 to 5 based on their self-reported ability to chew the most difficult of five foods. In this representative sample, 77 percent scored 5. The index has high predictive values when compared to two other questions on chewing ability in the survey. Among those with chewing disability (scoring 0 to 4), the odds ratio (OR) for being edentulous was 4.1 (95%) Cl = 2.1-8.3). No factor influenced chewing ability among the edentulous. Among the dentate, several clinical dental health status measures appeared to influence chewing ability. Logistic analysis identified the absence of functioning opposing pairs of natural posterior teeth, OR 5.6 (95% Cl = 2.21-14.39), and the need for urgent care, OR 23.7 (95% Cl = 1.05-6.95), as the most important.     

Maxillary Sinus Lateral Wall Thickness and Morphologic Patterns in the Atrophic Posterior Maxilla

Background: The aim of the present study is to examine the sinus lateral wall thickness (LWT) of atrophic posterior maxilla (<10 mm) of patients with complete and partial edentulism and determine the influence of residual ridge height (RH), sex, and age on maxillary LWT. Methods: Four hundred fourteen measures were taken from 140 consecutive patients that met the inclusion criteria. On the selected sagittal section, a built‐in digital caliper recorded in millimeters the RH and LWT (a perpendicular line at 3, 5, 7, 10, 13, and 15 mm from the lowest point of the sinus floor). Edentulous spans were further classified as complete edentulous atrophic maxilla (CEM) and partial edentulous atrophic maxilla (PEM). The mixed linear model was used to test the effects of sex, type of edentulism, edentulous span, and RH on the measurement of the LWT of the sinus. Results: Mean LWT for PEM was 1.71 ± 0.12 mm, and for CEM, 1.57 ± 0.07 mm (P = 0.01). The mixed model yielded significant effect of edentulous span (P = 0.048) and interactions among type of edentulism and edentulous span (P <0.001) and edentulous span by RH (P <0.01). Age and RH were positively associated with LWT; however, they did not interact with RH, sex, or type of edentulism. RH has been shown to correlate with edentulous span (P <0.001) and type of edentulism (P = 0.01). The longer the edentulous span, the thinner the LWT. Similarly, RH was larger for PEM (6.85 ± 0.34 mm) than CEM (5.69 ± 0.26 mm). Conclusions: The maxillary sinus lateral wall tends to increase in thickness from the second premolar to the second molar and from 5 mm up to 15 mm. In addition, RH, presence of teeth adjacent to the edentulous atrophic ridge, and age were shown to influence maxillary sinus LWT.     

Receipt of dental care, dental status and workforce in U.S. nursing homes: 1997 National Nursing Home Survey

The goal of this paper was to report the prevalence of dental care — a Healthy People 2010 objective — for nursing home residents 65 years and older, and to assess the association between receipt of dental care with other oral status and workforce measures. Data from 7,363 residents aged 65 years and older with information in the 1997 National Nursing Home Survey (NNHS) were used.
Overall, 18.2% of elderly nursing home residents had received dental care in the last month. Multivariable modeling found residents were more likely to receive dental care in the past month if they lived in the Northeast (OR=3.32, 95% CI 2.51-4.39); were dentate (OR=1.46, 95% CI 1.26-1.69); had a length of stay 12 months or longer (OR=1.37, 95% CI 1.17-1.62); or resided in facilities with dental professional services (OR=2.05, 95% CI 1.60-2.62).
The results showed that disparities in receipt of dental care existed by region, length of stay, dentate status, and availability of dental services in nursing homes. Additionally, current oral health surveillance measures for nursing homes may have been inadequate.     

The Influence of Dental Insurance on Institutionalized Older Adults in Ranking Their Oral Health Status

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel‐Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as “good,”“very good” or “excellent” by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting “good,”“very good” or “excellent” oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.