Oral health in predialysis patients with emphasis on diabetic nephropathy

We investigated oral health of chronic kidney disease (CKD) patients at predialysis state. The hypothesis was that diabetic nephropathy affects oral health more detrimentally than other CKD patients due to the known risk diabetes presents in this regard. We expected worse oral health and particularly poor periodontal health among the diabetic patients. A cross-sectional study was conducted in the Helsinki University Central Hospital, Finland, on 148 patients with different kinds of kidney disease at predialysis state. Data from medical records, clinical oral examination, saliva, and mucosal yeast counts were analyzed and compared between the disease groups. Of the patients, 53 (36%) had diabetic nephropathy (29 patients with type 1, 24 patients with type 2 diabetes). Compared with other CKD patients, diabetic patients had poor glycemic control as expected (mean HbA_1C 8.0% vs 5.9%, p < 0.01). Diabetic patients also had more dental caries (mean number of carious teeth 5.1 vs 3.1, p < 0.01) and lower salivary flow rates than other CKD patients (stimulated salivary flow 1.2 ml/min vs 1.6 ml/min, p < 0.05). No difference between groups was observed in periodontal health and yeast counts. In conclusion, diabetic nephropathy patients indeed had worse dental health in comparison to CKD group. However, contrary to our expectation, diabetic nephropathy did not seem to affect periodontal health more severely than the other kidney diseases.     

A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and selfperceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gendermatched non-diabetic controls. Oral health variables were also related to glycemic control (HbA_1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%). Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff.     

A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and self-perceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gender-matched non-diabetic controls. Oral health variables were also related to glycemic control (HbA1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%. Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff.     

Oral health and health-related quality of life in type 2 diabetic patients and non-diabetic controls

The aim of the present study was to identify factors in oral health and also diabetes-related and socio-economic components that could be associated with the subject's health-related quality of life (HRQL). One-hundred-and-two randomly sampled type 2 diabetic and 102 age-matched and gender-matched non-diabetic subjects from the same residential area were studied cross-sectionally using the SF-36 questionnaire. Although the HRQL profiles were similar in nature, the control subjects indicated a more favorable health status in their HRQL scores than did type 2 diabetic subjects. Certain oral health factors contributed to deterioration of the patient's HRQL. Multiple regression analyses including both groups were used to determine variables explaining variance in the different HRQL domains. Dissatisfaction with teeth and mouth, feeling of dry mouth and poor financial status contributed to about one-fourth of the explanation of the variance in all health domains. Having diabetes played an important role in the domains Physical Functioning, Role functioning--Physical, General Health, and Social Functioning. Age was important for Physical Functioning and Role functioning--Physical. Our study indicates that different factors may be associated with impaired HRQL, especially among type 2 diabetic subjects, although only a partial understanding of its relation to oral health could be demonstrated.     

Periodontal conditions and prevalence of putative periodontopathogens and Candida spp. in insulin-dependent type 2 diabetic and non-diabetic patients with chronic periodontitis--a pilot study

Objectives

The aims of this study were to evaluate periodontal conditions and identify the presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia, and four different species of Candida (C. albicans, C. dubliniensis, C. glabrata and C. tropicalis) in periodontal pockets and furcation sites of insulin-dependent type 2 diabetic and non-diabetic patients with generalised chronic periodontitis.

Design

Clinical parameters, including oral status assessed using plaque index, gingival index, probing depth, gingival recession and clinical attachment level and systemic conditions with fasting glucose level or glycosylated haemoglobin were measured in diabetic and non-diabetic patients with chronic periodontitis. Samples of subgingival biofilm were obtained from the periodontal pockets and furcation sites and submitted to phenol-chloroform DNA extraction and PCR analysis using specific primers.

Results

Clinical conditions of diabetic and non-diabetic patients were similar, without statistical differences in both periodontal indexes and glucose levels (p > 0.05). Diabetics had a higher prevalence of Candida spp., mainly C. albicans and C. dubliniensis, and a lower frequency of T. forsythia, when compared to non-diabetic patients, for both periodontal sites. C. glabrata and C. tropicalis were not found in periodontal pockets and furcation sites of non-diabetic patients.

Conclusion

The results demonstrated a strong colonisation of Candida spp. in the periodontal sites of diabetic patients that have generalised chronic periodontitis with a higher prevalence of C. dubliniensis followed by C. albicans.     

Reimbursement for the oral health care of cancer patients.

Oral conditions related to cancer therapy, which are largely preventable, continue to result in considerable morbidity, dysfunction and lost quality of life. Therefore, it is important for dentists to be knowledgeable about the problems of reimbursement for the oral health care of cancer patients and become involved in the issue of access to oral health care for cancer patients.     

Aging and oral health care in The Netherlands. An explorative study

In order to investigate which initiatives are being taken in The Netherlands to anticipate a change in oral health care demands as a result of ageing, 9 experts in the field of oral health care for the elderly were interviewed. The experts were selected because of their varied expertise and involvement in geriatric dentistry. Those interviewed were unanimous in the opinion that the demand for oral health care among the elderly will increase in the years to come. National initiatives to improve oral health care for the elderly appear to be limited. This situation can be changed by getting professional homecare more involved in oral health care for the elderly, and by regular dental checkups, stimulated by more actively operating general dental practitioners. For those in homes for the elderly and nursing homes, there appears to be no national policy with regard to oral health care. Several initiatives have been undertaken to improve dental health care, but those differ from institution to institution. According to the interviewed experts, financing, government prioritization, and health care laws are major bottlenecks on the road to the improvement of oral health care for the elderly.     

Extent and severity of chronic periodontitis in chronic kidney disease patients

Brito F, Almeida S, Figueredo CMS, Bregman R, Suassuna JHR, Fischer RG. Extent and severity of chronic periodontitis in chronic kidney disease patients. J Periodont Res 2012; 47: 426–430. © 2011 John Wiley & Sons A/S Background and Objectve: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross‐sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. Material and Methods: Forty CAPD patients (mean age 52 ± 12 years), 40 HD patients (mean age 50 ± 10 years), 51 predialysis patients (mean age 54 ± 11 years) and 67 healthy individuals (mean age 50 ± 7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥ 6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥ 4 mm were considered to have generalized chronic periodontitis. Results: Predialysis and HD patients had significantly more sites with clinical attachment loss ≥ 6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. Conclusion: Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.     

Policy and research in oral health care.

The purpose of the paper is to highlight the interrelationship between social and health policy, and health services research. The principles and concepts in social and health policy in the Scandinavian welfare states are described with reference to oral health care. The concept of policy analysis is defined and distinctions are made between "analysis of policy", and "analysis for policy". The policy perspective is discussed with the focus on the planning--budgeting--implementation--evaluation cycle and related to the WHO Strategy for Health for All. Finally, the implications for oral health services research in Scandinavia are emphasized.     

��ǻҽ�Ʒ����е�ҽ����ͨ

优秀的口腔医疗服务需要服务团队整体具备良好的人文素质和沟通能力,本文探讨了口腔医患沟通的相关问题：医患沟通不仅仅是介绍和推荐医疗项目,而是以表达关爱,交流信息和情感为基础,以积极的心态为前提;口腔医患沟通的参与者不仅是医生和患者两个人,还有团队、机构、行业以及患者的社会关系;本文还讨论了口腔医患沟通的技巧、内容以及如何提高医患沟通能力等方面的内容。希望对于缓解当今紧张复杂的医患关系提供一些帮助。     

An exploratory qualitative study of Otago adolescents' views of oral health and oral health care

OBJECTIVES: To investigate Otago adolescents' views of oral health and oral health care, in order to increase understanding of the influences on their use or non-use of free care. DESIGN: The study employed a qualitative approach, using focus groups and grounded theory analysis. PARTICIPANTS: Participants ranged in age from 13 to 18, and included both genders and a variety of educational attainments, ethnicities and family incomes. Focus groups were conducted in schools, training centres, a place of employment, a CYF (Child, Youth and Family) Home, and a University Hall of Residence. RESULTS: While aware of the normative pressure to attend for free dental care and engage in oral health care, Otago adolescents consider doing so to be "just so gay". They exhibit strongly held preconceptions about the expense of dentistry and the respective competence of dentists and dental therapists. The dental surgery environment was viewed as a major disincentive. Adolescent oral health beliefs centred on two models: the medicalised, pragmatic view of oral health (which valued the function of teeth); and the cosmetic view of oral health (which valued the aesthetics of teeth); or a combination of these two models. In both models, media advertising for oral health care products was a significant source of oral health information. The preferred oral health behaviour associated with the medicalised model was frequent use of chewing gum and rapid toothbrushing, and, for the cosmetic model frequent use of chewing gum and breath fresheners. CONCLUSIONS: These findings support the international literature on the use/non-use of dental services even when the financial barriers to seeking such services has been removed. New Zealand dental care has developed without reference to the changing norms of youth culture, and the conventional dental practice setting is not viewed by adolescents as being inviting or appropriate. Increasing the uptake of free oral health care by that group will require some innovative approaches.