Complete dentures in the prosthetic rehabilitation of elderly persons: five different criteria to evaluate the need for replacement

summary The purpose of this study was to examine the condition and functional properties, as well as adjustment and replacement needs, of 288 complete dentures worn by 144 inhabitants of Helsinki over 75 years old. Five different criteria to evaluate the need for replacement were used: (I) criteria based on Oral Health Surveys – Basic Methods (WHO, 1987); (II) criteria based only on the clinical data collected during the examination; (III) criteria based only on examiners' subjective opinion of the condition of the dentures; (IV) criteria based on clinical data as well as examiners' experience and consultation with the patient; (V) criteria based only on patients' subjective opinion. Depending on the evaluation method used, 10–84% of the dentures were judged to be in need of replacement. Strict objective evaluation methods produced the highest figures for replacement need, and method (I) (WHO, 1987) the lowest. The most justifiable replacement percentage (26%) was achieved when the dentist assessed treatment need together with the patient. This study documents the multiple subjective and objective difficulties related to the wearing of complete dentures. The study also highlights the well-recognized importance of regular annual re-examinations for those wearing complete dentures and the assessment of need for adjustment of the dentures. It also demonstrates that successful treatment decisions cannot be made solely on the basis of clinical examination or a dentist's subjective opinion, but should be formulated in close consultation with the patient.     

Biopharmaceutics: Different Absorption Profiles of Deramciclane in Man and in Dog

We have studied the dog model for predicting the oral absorption of deramciclane, a novel anxiolytic compound, as a model acid-labile drug. The absorption profile of deramciclane was studied in man and beagle dogs after administration of conventional capsules and enteric coated tablets. Absorption in dogs pretreated with pentagastrin or saline was also studied after administration of conventional capsules. The in-vitro stability of deramciclane was determined over the pH range 1.2–6.0. The rate of degradation of deramciclane increased ten-fold as the pH was reduced from 2.1 to 1.2 (t.β (elimination half-life) 9 h and 39 min, respectively). Deramciclane was stable at pH. 3. The two formulations were bioequivalent in dogs and there were no significant differences between pharmacokinetic parameters measured for dogs pretreated with pentagastrin or saline. In man the mean relative bioavailability and C_max (peak plasma concentration) for the conventional capsules were approximately 75% and 83% of those for the enteric coated tablets (P = 0.0004 and P = 0.0031, respectively). This was probably because of degradation of deramciclane at lower pH of man's stomach compared with that of the dog. Pentagastrin was probably unsuccessful in reducing gastric pH and thus no change in absorption was observed. It is concluded that the absorption of deramciclane, and possibly other acid-labile drugs, cannot be predicted by use of the dog model.     

Prosthetic rehabilitation in the elderly inhabitants of Helsinki, Finland

The aim of this study was to document the number of remaining natural teeth, to examine the prosthetic rehabilitation and to evaluate further prosthetic treatment needs among a representative sample of 76–86-year-old inhabitants of Helsinki. The edentulous made up 46% (168) of the subjects, 40% of the men and 48% of the women. Of these edentulous, 94% (158) wore complete dentures in both jaws, 2% wore only a maxillary denture, and 4% wore no dentures at all. One edentulous subject had an implant-supported overdenture in the lower jaw. More than half (54%) of all subjects had 1–32 natural teeth left. These dentate subjects had 47% (mean 13·2, excluding the wisdom teeth) of their natural teeth remaining. Of the remaining teeth, 13% (mean 1·8) were crowned and 5% (mean 0·6) were indicated to be extracted. Among the dentate, 37% (mean 10·4) of their natural teeth were missing and replaced by some type of fixed or removable prosthesis. Eleven per cent (mean 3·1) of missing teeth had not been replaced and were considered not to need prosthetic replacement. However, 5% (mean 1·3) of the missing teeth without prosthetic replacement were judged to need a prosthesis. Among the dentate, 37% wore a complete denture in one jaw; 34% of the dentate subjects used acrylic removable partial dentures (ARPD), and 19% used metallic removable partial dentures (MRPD). Of the dentate, 45% had crowns and fixed bridges. Altogether, 25% wore some kind of combination of fixed and removable prosthesis, whereas 14% had no type of prosthetic rehabilitation at all. The age of the current prosthesis varied from less than one year to over 50 years. Of all the subjects, 37% (6% of the edentulous and 63% of the dentate) had experienced inadequate prosthetic rehabilitation.     

PRACTICE OF QUALITY ASSURANCE IN BLOOD CENTERS — THE SYSTEM AND DAILY WORK

Using process documentation is not an occasional activity that gets done, but rather must be woven into the very fabric of an organization's activities and values. Management must take active leadership roles in the quality process. If management gets involved in the implementation of the quality program, and makes quality a strategic part of their business plan, it will result in a more focused organization, that can more effectively meets its financial requirements and be increasingly competitive in the ever more competitive environment of health care in the 21st century. To do that will require that blood banks learn how to consistently apply the use of quality records, audits, training, and quality metrics. The table and graph demonstrate the areas where blood bank management can work more effectively to lead their organizations beyond GMP and into the quality systems world of the future.     

Skin test reactivity to molds in pre-school children with newly diagnosed asthma

BACKGROUND: The aim of the present study was to evaluate the prevalence of sensitization to molds and to house dust mites (HDM) in pre-school children with newly-diagnosed asthma. METHODS: From 1996 to 2000, 122 children 1 to 6 years of age with fresh asthma treated in the Kuopio University Hospital, Kuopio, Finland, were recruited in the study; 94% attended. Skin prick tests were performed to common inhalant allergens and to 10 molds. The homes were surveyed for moisture damage. RESULTS: A majority of the houses had signs of dampness and moisture. One-third of the children reacted to inhalant allergens. There were 11 positive reactions to molds in five children who all reacted to at least one animal dander or seasonal pollen. Aspergillus fumigatus, Botrytis cinerea, and Cladosporium herbarum were the most common mold allergens. There were only two children with positive reactions to HDM, and none of them reacted to molds. No associations were found between the presence or degree of moisture problems at home and mold or HDM allergy. CONCLUSION: Sensitization to molds seems to play only a minor role in pre-school children with newly-diagnosed asthma in a northern climate where the incidences of mold and HDM allergies are rather low.     

Oral mucosal lesions and oral hygiene habits in the home-living elderly

summary A large epidemiological health investigation, the Helsinki Ageing Study (HAS), was performed in 1989–1991 in Helsinki, Finland. We report here the prevalence of oral mucosal lesions in 338 76-, 81- and 86-year-old home-living elderly people, who completed the oral health investigation at the Institute of Dentistry, University of Helsinki. One or more lesions were found in 128 subjects (38%). Fifty-one per cent of the edentulous complete-denture wearers and 31% of the elderly with some natural teeth had mucosal lesions. The most common finding was inflammation under the denture, which occurred alone or combined with other lesions in 25% of the denture wearers. The three most common mucosal changes not related to denture wearing were coated changes of the tongue (7%), angular cheilitis (6%) and varicose veins under the tongue (4%). No differences were found in the number of mucosal lesions among the three age groups. Angular cheilitis and inflammation under removable dentures were more frequent in women than in men. However, no other differences were found in the presence of mucosal lesions between sexes. The total number of mucosal lesions correlated positively with the number of medications used daily. Ninety-six per cent of the subjects with complete dentures, and 98% of those with some natural teeth reported cleaning their dentures at least once a day. Of the denture wearers, 88% reported cleaning their oral mucosa also, as part of their oral hygiene routine. The presence of mucosal lesions was related to self-reported cleaning of the denture-bearing mucosa. However, no association was observed between cleaning frequency and presence of mucosal changes.     

Distension of pulmonary vein—left atrial junction: Heart rate responses in conscious and anesthetized dogs

The cardiac chronotropic effects of distension of pulmonary vein-left atrial junction were investigated in conscious dogs and in dogs anesthetized with intravenous alpha-chloralose (100 mg/kg) or pentobarbital (30 mg/kg). All the experiments were made on trained, chronically instrumented, closed chest animals held in horizontal position. Inflation of a single small balloon in the junction elicited a tachycardic response both in conscious and chloralose-anesthetized dogs, while in pentobarbital anesthesia no change in heart rate was found. Contrary to reports of other investigators, no transient bradycardia was found, nor any correlation between predistension heart rate and the increase in heart rate due to the distension. It is suggested that the choice of anesthetic can be done only after its modifying effect on the parameter studied is known. Only the use of trained, chronically instrumented and conscious dogs will reveal this effect.     

Group IIA phospholipase A2 as a prognostic marker in prostate cancer: relevance to clinicopathological variables and disease‐specific mortality

Group IIA Phospholipase A₂ (PLA2‐IIA), a key enzyme in arachidonic acid and eicosanoid metabolism, participates in a variety of inflammatory processes but possibly also plays a role in tumor progression in vivo. Our aim was to determine the mRNA and protein expression of PLA2‐IIA during prostate cancer progression in localized and metastatic prostate tumors. We evaluated the prognostic significance of PLA2‐IIA expression in biochemical recurrence, clinical recurrence and disease‐specific survival after surgical treatment. The expression of PLA2‐IIA was examined by immunohistochemistry and chromogenic in situ hybridization in tissue microarrays of radical prostatectomy specimens and advanced/metastatic carcinomas. The expression data were analyzed in conjunction with clinical follow‐up information and clinicopathological variables. The mRNA and protein expression of PLA2‐IIA was significantly increased in Gleason pattern grade 2–4 carcinomas compared with benign prostate (p‐values 0.042–0.001). In metastases, the expression was significantly lower than in local cancers (p=0.001). The PLA2‐IIA expression correlated positively with Ki‐67 and α‐methylacyl CoA racemase (AMACR) expression. The prognostic evaluation revealed decreased PLA2‐IIA protein expression among patients who had died of prostate cancer. In conclusion, PLA2‐IIA expression is increased in carcinoma when compared with benign prostate. However, metastatic carcinoma showed decreased expression of PLA2‐IIA when compared with primary carcinomas. PLA2‐IIA may serve as a marker for highly proliferating, possibly poorly differentiated prostate carcinomas. The protein expression of PLA2‐IIA may be diminished in patients who consequently die of prostate cancer.     

Comparison of partial and full crowns as retainers in the same bridge

summary The purpose of this study was to assess longitudinally the success of partial and full crown abutment pairs in the same bridges. Fifty patients with a mean age of 45 years (range 22–70 years) were examined during spring 1981 (1–5 year follow-up), 33 of whom were examined a second time during spring 1990 (10–15 year follow-up). The status of the partial crowns, full crowns, and their abutment teeth was assessed using standardized questions, and clinical and radiographic examinations. At the first follow-up examination, all partial and full crowns, and consequently all bridges, were still in use. Before the second follow-up examination one of the full crown abutments had become badly decayed, and the bridge, including the partial crown, had been removed. The failure rate was 0.2% per year for the full crown as a unit, and consequently 0.2% per year for the bridge as a unit.