Dental screening of long stay geriatric patients in West Essex and recommendations for their care

A dental screening programme at a West Essex Health Authority hospital provided data from 151 in-patients, most of whom were in long-stay geriatric care. 71 per cent were female and the mean age of the geriatric patients was 81 years. 61 subjects (40 per cent) suffered predominantly from mental illness. 107 subjects (71 per cent) were edentulous but a higher proportion of elderly mentally ill patients (42 per cent) had retained some of their natural teeth compared with 20 per cent of the others. 26 edentulous subjects were not in possession of any dentures and the standard of oral and denture hygiene was poor. 59 in-patients (39 per cent) had 'expressed' need for dental treatment and a further 51 (34 per cent) were unable or unwilling to communicate their need. An important aspect of their dental care was the provision and maintenance of a preventive dental programme for both dentate patients and denture wearers.     

Self-reported medical problems among dental patients in Western Uttar Pradesh, India

Assessing the medical history of patients before any treatment is an essential aspect of the dentist's responsibility; however, many dental practitioners assume that their patients are systemically healthy so their medical history is often overlooked. The objective of this study was to determine the prevalence of self-reported medical conditions among a sample of dental school patients at the Institute of Dental Sciences, Bareilly (Uttar Pradesh), India. Detailed medical histories were taken from 3,786 new dental patients in an outpatient setting. The demographic data, medical status, and use of medications from the charts were analyzed. Thirty-eight percent of the total patients had a positive finding in their medical history for at least one systemic condition. The most commonly reported systemic condition was hypertension (15.2 percent) followed by diabetes (11.4 percent), and 26 percent of the patients were taking at least one medication daily. The results of this study reflect the medical complexity of the increasingly aging population.     

Survey of drug used and medical history among dental out-patients

Information about drug used and medical history among dental patients would be useful for dental practice and teaching of clinical pharmacology. Therefore, 541 consecutive adult outpatients of Mahidol dental school were studied in 1987. The names of drug used and medical problems were obtained by direct questioning. Out of patients surveyed, 307 (56.7%) were taking drugs and the most commonly drug used was non-narcotic analgesics. 300 patients (55.4%) had medical problems and allergy was the most common disease. The frequency of patients who taking drugs and having medical problems varied between age groups. The highest frequency of medication intake was found in patients with age above thirty. The highest frequency of significant medical conditions was found in patients with age above fifty. The data from this investigation revealed that the medical problems of patients which affect dental treatment were very common. Consequently, the dental personnel should study more about the pharmacology of systemic drugs and the nature of systemic diseases.     

Periodontal status and treatment needs among regular dental patients

A survey of periodontal status and treatment needs among dental patients was performed using the CPITN criteria, with the worst score per sextant being recorded, based on examination of all surfaces of all teeth. Regularly attending patients (n = 1092) from 36 general dental practices in two North Carolina counties were examined. The most frequently found worst conditions-per-patient across all ages were the presence of calculus (35 per cent) and the presence of 4-5 mm pockets (35 per cent). The most common worst condition-per-sextant was bleeding (32 per cent) followed by calculus (28 per cent). Less than a fifth of all sextants exhibited pocketing, although half of the patients had at least a 4-5 mm pocket. The mean amount of treatment time required for these conditions was 33 minutes, reflecting the general absence of the need for complex periodontal treatment.     

Oral conditions and their social impact among HIV dental patients

This study aimed to assess oral health status and the social impact of oral conditions among dental patients with HIV infection in comparison with general dental patients receiving public-funded care in Adelaide, South Australia. DMFT and CPITN indices were recorded by one dentist at a clinic for HIV dental patients. The data were compared with information from an existing survey of general dental patients. Social impact was assessed using the Oral Health Impact Profile questionnaire and responses from HIV dental patients were compared with responses from a telephone interview survey of Adelaide residents. HIV patients were aged 21 to 49 years (median *** 34), 90.7 per cent were male and 29.6 per cent had stage 4 HIV infection. Oral candida was present among 32.0 per cent, hairy leukoplakia among 24.1 per cent, HIV gingivitis among 18.5 per cent, and HIV periodontitis among 33.3 per cent. The DMFT index and its components did not differ significantly between HIV and general dental patients, while CPITN scores were lower among HIV patients (p = 0.01). However social impact among HIV patients was frequent: 64.6 per cent reported toothache, 43.7 per cent avoided foods, and 16.7 per cent avoided going out because of dental problems. HIV patients reported significantly greater levels of social impact than the Adelaide sample (p < 0.01). Patients to this clinic frequently presented with severe and disabling oral conditions which were not adequately captured using standard clinical indices.     

Provision of domiciliary dental care for the older person by general dental practitioners in Scotland.

The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided, via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P less than 0.001). In Scotland, approximately 1 per cent of 70-79-year-old patients and 2 per cent of patients over 80 years received domiciliary dental care over a 1-year period. For those elderly people who received such care, the mean percentage doubled for every 5-year increase in patient age.     

Diagnosis and treatment of dental emergencies in two Finnish cities

According to the present clinical survey of dental emergencies treated by organised emergency services in two of the larger Finnish cities, the main causes (64 per cent) of the problems leading to these visits were caries and its consequences. In about 80 per cent of the 839 cases treated, the acute treatment was based on clinical examination only. Temporary fillings were provided for 19 per cent, permanent fillings for 8 per cent, endodontic treatment for 22 per cent and extractions for 14 per cent of the patients. Extractions were most often provided for patients who normally visited a dentist irregularly and these had a low mean number of teeth. Patients with pain lasting longer than a week were likely to receive endodontic treatment, whereas permanent fillings were provided for regular dental visitors who had their own dentists. About 90 per cent of the patients were considered to need other dental treatment in addition to the treatment of the acute condition.     

Severe odontogenic infections

Background : Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.
Methods : All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.
Results : Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.
Conclusion : Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.     

Precautions reported to be used against cross-infection and attitudes to the dental treatment of HIV-positive patients in routine clinical dental practice in Scotland

The purpose of this study was to ascertain the precautions against cross-infection currently employed in routine practice by Scottish dentists, to relate these to current recommendations and to determine Scottish dentists' views on how dental treatment should be provided for patients known to be HIV positive. The subjects were 926 general dental practitioners and 201 clinical community dental officers among respondents to a questionnaire sent to a list of 1726 dental practitioners in Scotland. The results suggest that while some dentists are prepared to take an element of personal risk (in spite of recent improvements 18 per cent are still unvaccinated against hepatitis B, 66 per cent do not wear surgical gloves during routine treatment and 21 per cent claim not to wear gloves during procedures involving ‘bloodletting’), the vast majority (95 per cent) are nevertheless taking steps to protect their patients from cross-infection by using autoclave and dry heat sterilization. One-quarter of general dental practitioners and one-half of clinical community dental officers felt that HIV-positive patients should generally be treated in the branch of the dental service in which they worked, although greater proportions (52 per cent and 69 per cent respectively) said they were prepared to treat a regular patient who became HIV positive.     

A report on the feasibility of establishing a paediatric emergency dental service at Glasgow Dental Hospital.

A six-month pilot emergency service for children was established at Glasgow Dental Hospital to provide care for patients in pain, offer preventive advice and ensure ongoing dental care. The service was staffed by experienced community dental officers. In the main study period 2965 patients were seen. The majority (54 per cent) were referred from general dental practitioners; however, 27 per cent came directly to the hospital without seeking dental advice in their locality. The most common problems were toothache (55 per cent), occasional pain (28 per cent) and swelling (14 per cent). Eighty per cent of the patients were directed to oral surgery for extractions under general anaesthesia and six per cent for extractions under local anaesthesia. Dental caries still causes pain and distress to a large number of Glasgow school children. Clearly water fluoridation would greatly improve dental health and in so doing reduce the proportion of children requiring extractions under a general anaesthetic. The emergency service is currently being reorganised so as to place more emphasis on following up those patients who do not have a dentist, or who presented for care without a referral letter.     

The effect of fluoride consumption and social class on dental caries in 8-year-old children

School dental service data indicate that whilst Melbourne eight-year-old children had worse dental health than similar children in the Geelong area in 1979, the situation in 1985 was the reverse. In order to investigate this, and determine the effects of socio-economic level (SEL), residential history, and fluoride history on dental caries status, 208 eight-year-old children in the Melbourne area and 209 eight-year-old children in the Geelong area were examined for dental caries. A questionnaire was administered to gain details of subjects' exposure to water and supplement fluorides. The SEL of the subjects' school was used in place of individual SEL. A high proportion (46 per cent) of Geelong subjects used a fluoride supplement at some stage, but few continued this for most of their life. Residential history was important, with 2.4 per cent of the Melbourne subjects living most of their life in a nonfluoridated area and 3.4 per cent of Geelong subjects living most of their life in a fluoridated area. There was a significant difference between the dmft in Melbourne and Geelong when only children who had lived all their life in the city in which they were examined and did not use a fluoride supplement were included. A large part of this difference is attributed to water fluoridation in Melbourne. A substantial number of children would benefit from fluoridation of the reticulated water supply in Geelong, particularly those in the lower social classes.     

Medical conditions associated with missing teeth and edentulism in the institutionalized elderly

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well-described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentuIism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low'as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth-by-tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.     

Oral health of children with gastro-esophageal reflux disease: a controlled study

BACKGROUND: The aim of this study was to compare the dental health of children with gastro-esophageal reflux disease (GERD) with a healthy control group. METHODS: Dental examinations were conducted for 52 children (31 boys and 21 girls) with a definitive history of GERD. For every subject enrolled in the study, a healthy control sibling without the condition was recruited. Medical histories were obtained from medical records, and dental and dietary histories were obtained from parents. The teeth were examined for erosion, dental caries, and enamel hypoplasia, and sampled for Streptococcus mutans. RESULTS: The prevalence of erosion by teeth was found to be statistically significant between GERD patients (14 per cent) and controls (10 per cent) (p<0.05). GERD patients had erosion in more permanent teeth compared to controls (4 per cent vs 0.8 per cent, p<0.05), and more severe erosion (p<0.05). Caries experience was also higher in GERD patients compared to controls (p<0.05). Although there were more subjects with Streptococcus mutans in the GERD group compared to the control group (42 per cent vs 25 per cent), the difference was not statistically significant. CONCLUSIONS: Children with GERD have more erosion and dental caries compared to healthy controls and should be targeted for increased preventive and restorative care.     

Problems associated with restorative materials--dentists' views in Finland and Sweden

During the past 10-15 years the possible side-effects of dental restorative materials, especially due to amalgam fillings, have caused a lively debate in Sweden. There is an extensive literature on the chemical and biological properties of dental materials but no investigations have dealt with the providers' attitudes. The purpose of this study was to find out the dentists' experiences of and attitudes to patients who state they have problems related to dental restorative materials and compare the dentists' subjective assessments of those side-effects in two neighboring countries, Finland and Sweden. Information was collected by postal questionnaires addressed to dentists chosen at random in Finland (n = 625) and in Sweden (n = 960). The response rate was 73 per cent and 72 per cent respectively. The results showed that 99 per cent of the respondents had patients questioning the safety of dental materials. The number of such patients was estimated to be three times higher in Sweden (124 patients per dentist in 1989) than in Finland (39 patients per dentist). More than 90 per cent of the questions from the patients regarded amalgam fillings. Statistically significant differences were found between the respondents' opinions of amalgam, 81 per cent of the Finnish contrary to 59 per cent of the Swedish respondents considered the risk of side-effects to be low when using this material. About 90 per cent of the respondents considered glass-ionomer, gold and ceramic restorations safe, but only half of them were convinced of the safety of composite. A great majority of the Swedish respondents (79 per cent) claimed that the patients should get their fillings changed without odontologic indications if they insisted on it and paid for the treatment in comparison to 22 per cent of the Finnish respondents (p less than 0.001). In case dental insurance was to pay for this kind of treatment it was accepted by 6 per cent of the Finns and 25 per cent of the Swedes. The attitude to amalgam was in general less favorable among the dentists in Sweden than in Finland.     

Minor salivary gland carcinoma involving the oral cavity or oropharynx

BACKGROUND: Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. METHODS: Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980-2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner. RESULTS: A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22-86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low-grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow-up 83 per cent of patients were alive and disease free. CONCLUSIONS: Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.     

Dental injuries at the 1989 Canada games: an epidemiological study.

The management and prevention of dental trauma is an integral part of the medical services provided at major athletic events. This paper reviews the organization and delivery of the dental services provided at the 1989 Canada Games. The nature, incidence and management of the dental problems reported in the participant population of 3,411 athletes are also described. During the two-week competition, 15 participants were assessed and treated for various dental conditions, including hard- and soft-tissue injury of the oral cavity, and temporomandibular joint sprain. The sports with the highest incidence of dental injury for the male population were wrestling (one per cent) and basketball (0.8 per cent). For the female population, these sports were basketball (2.5 per cent) and field hockey (1.3 per cent). The dental services provided during the games included emergency assessment and treatment, fabrication of mouthguards, and in-service education to medical team members.     

CPITN assessments in institutionalised elderly people in Kitakyushu, Japan

A CPITN survey was conducted on 1958 institutionalised elderly people aged 59 years and older at 29 of the 30 public and private institutions in the city of Kitakyushu, Japan. About 60 per cent of the sample was edentulous, and the prevalence of periodontal conditions was high. The percentages of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets were 3, 4, 32, 52, and 9 per cent respectively. Half the sextants in the dentate subjects were scored as excluded (less than two teeth), indicating that many teeth were missing. Only very few sextants were healthy. These findings indicate the importance of preventive programmes for periodontal diseases in the younger generations, because (a) dental care for the elderly population becomes more difficult with increasing age and (b) periodontal care, if it is available at all, is provided too late for most people.     

The diagnosis and surgical management of major salivary gland pathology

BACKGROUND: Major salivary gland pathology is an uncommon but important finding which may initially present to general dental and medical practitioners. The consequences of misdiagnosis are important, as acute obstruction and neoplasia are the main pathological lesions diagnosed. The purpose of this study was to analyze a consecutive series of major gland pathologies treated surgically to determine diagnostic and treatment problems. METHODS: A retrospective analysis of all cases of the major salivary glands treated on an inpatient surgical basis over a five-year period by the Oral and Maxillofacial Surgery Unit of the Royal Adelaide Hospital was performed. Particular emphasis was placed on the referring diagnosis as compared to the final diagnosis. RESULTS: Fifty-four patients had surgical management of 62 major salivary glands over the five-year period. By gland, 18 (33.3 per cent) were parotid, 35 (51.1 per cent) submandibular and nine (16.6 per cent) were sublingual. Fifty-one (82 per cent) of all lesions were inflammatory and 11 (18 per cent) neoplastic. The most common presentations were swelling (72 per cent) and pain (33 per cent). Most patients were referred by general dentists (37 per cent), followed by general medical practitioners (32 per cent) and specialists (28 per cent). The referring diagnosis was correct for only 45 per cent of the dentists but 76 per cent for the general medical practitioners and 87 per cent for the specialists. Only two of the 11 gland neoplasms were correctly identified as neoplasms, both by specialists. The morbidity of the surgical treatment was low. CONCLUSION: The general dental practitioner is often the first health professional with the opportunity to assess salivary gland pathology, and therefore needs to be aware of the presenting signs and symptoms of major salivary gland lesions.     

Orthodontic treatment needs in Westmead Hospital Dental Clinical School

One hundred and fifty-four adolescents, 76 female and 78 male consented to take part in this survey. The two authors examined and assessed them for dental aesthetics, malocclusion related features and TMJ related signs. The patients were also questioned about their opinion of dental aesthetics, their interest in having orthodontic treatment and their TMJ symptoms. Only 63 per cent of the adolescents who were considered suitable for orthodontic treatment expressed an interest in wanting treatment. Twenty-seven per cent of patients had signs and/or symptoms of TMJ disturbance. No association was found between individual malocclusion problems and TMJ signs and symptoms. The authors considered 56.5 per cent of the total group for orthodontic treatment, the majority for aesthetic reasons, and placed them into high, medium and low priority groups. Fixed appliance therapy for both arches was the recommended type of treatment for most patients.