Current Dental Research…

Dental care for the elderly

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Last updated: January 2018 16/01/2018

1. Ettinger RL, Goettsche ZS, Qian F. Curriculum content in geriatric in USA dental schools. Gerodontology 2017, Oct 23. OBJECTIVES: The aim of this study was to re-examine the teaching of geriatric dentistry in the USA dental schools, to identify curriculum content and compare the findings to previous reports. METHODS: All dental schools in the United States were contacted via email with a questionnaire to assess the teaching of geriatric dentistry. Non-responding schools were sent a minimum of three reminder emails to complete the survey. A statistical analysis was performed. Descriptive statistics were conducted to profile the variables of interest. Bivariate analysis was performed to explore if any of the variables were related using Fisher's exact test, non-parametric Wilcoxon rank-sum test and the Kruskal-Wallis test. RESULTS: Fifty-six of the 67 dental schools completed the questionnaire. Geriatric dentistry was taught in all dental schools; for 92.8%, the course was compulsory. We found that 62.5% were teaching it as an independent course, 25% as an organised series of lectures and 8.9% as occasional lectures in parts of other courses. Clinically, 84.2% have some form of compulsory education in geriatric dentistry. Public schools were marginally associated with an increased interest in expanding the geriatric dentistry curriculum (P = .078). No differences were found between these variables and school location. CONCLUSIONS: Geriatric dentistry is now required in 92.8% of dental schools. The teaching of traditional topics has not changed much; however, the number of gerontological topics has increased. Clinical teaching needs to be expanded, as in only 57.1% of schools was it a requirement. The ageing imperative will require research to determine the impact of teaching on services to the geriatric community.

2. Waldman HB, Perlman SP, Schwartz AG, Larsen CD. , disabilities, dentistry, ethics and economics. Gerodontology 2017, Nov 24.

3. Brennan DS, Chrisopoulos S, Teusner DN. Hours worked and patient visits provided by in Australia. Australian Dental Journal 2017, Nov 22. OBJECTIVES: To examine numbers of hours worked and patient visits provided by age and sex of in Australia, and compare with previous estimates to describe trends. METHODS: Data were collected by mailed survey from a random sample (n=2,961) of Australian dentists. Private sector dentists working in clinical practise were included in the analysis. Data were weighted to the age and sex distribution of Australian practising dentists. RESULTS: The adjusted response rate was 49% (n=1,345 dentists). Hours per year worked and number of patient visits per year were lower for dentists aged 65+ years than younger dentists, and were higher for male compared with female dentists aged 35-45 to 55-64 years. Hours per year worked were lower in 2013-14 than reported in 2009-10, but the number of patient visits in 2013-14 was similar to the previously reported estimate from 2009-10. CONCLUSIONS: Hours worked and visits provided were only lower among older dentists aged 65 years or more. Male dentists tend to work more hours per year and provide more patient visits per year than female dentists. Over the last decade, Australian dentists maintained a stable output of visits per year

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despite a trend towards fewer hours worked per year. This article is protected by copyright. All rights reserved.

4. Rech RS, Hugo FN, Baumgarten A, Dos Santos KW, de Goulart BNG, Hilgert JB. Development of a simplified dysphagia assessment by dentists in older persons. Community Dentistry & Oral Epidemiology 2017, Dec 19. OBJECTIVE: This study aimed to evaluate the diagnostic accuracy of a simplified clinical examination of swallowing by dentists and the Eating Assessment Tool (EAT-10), when compared with the diagnosis provided by a speech pathologist (gold standard). METHODS: Three dentists and 1 speech pathologist clinically evaluated 265 older persons in southern Brazil, 123 were residents in long-term care and 142 were community-dwelling, all able to respond to the research protocol independently. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), and positive and negative likelihood ratios (+LR and -LR) were calculated according to standard methods. This study was approved by the Ethics Committee of the Federal University of Rio Grande do Sul. RESULTS: Mean age of the participants was 73.5 (+/-8.9) years and most of them were women (N = 157, 59.2%). The prevalence of dysphagia as diagnosed by a speech pathologist was 45.3%. The accuracy of diagnosis was 0.84 for the clinical examination of swallowing by dentists. Furthermore, sensitivity was 0.77, specificity was 0.89, +PV was 0.85, -PV was 0.83, +LR was 7.02 and -LR was 0.25. The accuracy of EAT-10 was 0.72, the sensitivity was 0.45, specificity was 0.94, +PV was 0.87, -PV was 0.67, +LR was 8.31 and -LR was 0.57. CONCLUSIONS: Simplified clinical examination of swallowing by dentists was found to be an accurate method to screen dysphagia in older persons.

5. Bhayat A, Chikte U. The changing demographic profile of dentists and dental specialists in South Africa: 2002-2015. International Dental Journal 2017 Sep 24. INTRODUCTION: It is essential to have regular audits of the number of oral health personnel so that planning, delivery of services and training can be addressed. There has not been such an audit in South Africa (SA) for more than 10 years. AIM: To determine the demographic profile of dentists and dental specialists (DS) between 2002 and 2015. METHODS: A retrospective record-based study was used and all dentists and DS registered with the Health Professions Council of South Africa (HPCSA) from 2002 till 2015 were included. Demographic data, including gender, age, race, type of practice and geographical residence were recorded. RESULTS: There were 6,125 dentists and 481 DS registered with the HPCSA in 2015. The younger dentists tended to be Black and Asian women while older dentists were mostly White males. The majority of DS with maxillo-facial surgeons (30%), orthodontists (30%) and prosthodontists (17%). The number of dentists increased at around 2% per annum and the majority of the dentists and DS resided in the most metropolitan provinces of SA. Over the 13-year period, the number of female dentists almost doubled and the number of Coloured, Black and Asian/Indian dentists and DS increased sharply. CONCLUSION: The population to dentist ratio was fairly low, with the majority of dentists and DS residing in the three metropolitan provinces of SA. There has been a relatively sharp increase in the number of Coloured, Black and female dentists, which could be a result of increased admission of previously disadvantaged students to dental schools.

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Hoeksema AR, Peters LL, Raghoebar GM, Meijer HJA, Vissink A, Visser A. Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death. Clinical Oral Investigations 2017 Sep;21(7):2189-2196. OBJECTIVES: The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. MATERIALS AND METHODS: Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in all new long-stay patients (n = 725) admitted to a nursing home between January 2009 and December 2013. All patients were followed from admission until death or until they left the nursing home. RESULTS: At admission, patients were significantly older than somatic patients; median [IQR] ages were, respectively, 85 [79-89] and 81 [76-87] (p = 0.001). In addition, edentulous patients were significantly older than patients with remaining teeth, 83 [79-89] versus 80 [74-86] (p = 0.001) years. Thirty percent of the admitted patients died within 12 months after admission. A small minority (20%) of the patients had their own teeth. In this group, poor (72%), caries (70%), and broken teeth (62%) were frequently observed. Edentulous patients were significantly more cooperative with treatment than patients with remaining teeth (64 versus 27%). Finally, significantly less professional dental care was given to edentulous patients when compared to patients with remaining teeth (median 90 [IQR 60-180] versus 165 [75-375] min). CONCLUSION: When compared to edentulous elderly patients, patients with remaining teeth were younger at admittance, were more often non-cooperative, and had a poorer oral health and higher need for dental care. CLINICAL RELEVANCE: It is important that health care workers ensure adequate oral health and dental care to frail elderly, especially for elderly with remaining teeth.

7. Brondani M, Pattanaporn K. Dental students' reflections about long-term care experiences through an existing model of oral health. Gerodontology 2017 Sep;34(3):326-333. OBJECTIVE: The aim of this study was to explore students' reflective thinking about long-term care experiences from the perspective of a model of oral health. MATERIALS AND METHODS: A total of 186 reflections from 193 second-year undergraduate dental students enrolled between 2011/12 and 2014/15 at the University of British Columbia were explored qualitatively. Reflections had a word limit of 300, and students were asked to relate an existing model of oral health to their long-term care experiences. We have identified the main ideas via a thematic analysis related to the geriatric dentistry experience in long-term care. RESULTS: The thematic analysis revealed that students attempted to demystify their pre-conceived ideas about older people and long-term care facilities, to think outside the box, for example away from a typical dental office, and to consider caring for elderly people from an interprofessional lens. According to some students, not all domains from the existing model of oral health were directly relevant to their geriatric experience while other domains, including interprofessionalism and cognition, were missing. While some participants had a positive attitude towards caring for this cohort of the population, others did not take this educational activity as a constructive experience. CONCLUSIONS: The nature of most students' reflective thinking within a long-term care experience showed to be related to an existing model of oral health. This model can help to give meaning to the dental geriatric experience of an undergraduate curriculum. Such experience has been instrumental in

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overcoming potential misconceptions about long-term care and geriatric dentistry.

8. Merz MA, Terheyden H, Huber CG, Seixas AA, Schoetzau A, Schneeberger AR. Facilitators and barriers influencing the readiness to receive dental implants in a geriatric institutionalised population-A randomized non-invasive interventional study. Gerodontology 2017 Sep;34(3):306-312. OBJECTIVE: Although elderly people have many serious dental issues and are in need of prosthesis, few opt for dental implants. The aim of this study was to investigate barriers that prevent elderly people from receiving dental implants. Specifically, we examined (i) whether the message was delivered before or after the interview had an impact, and (ii) whether it did matter who delivered the message. MATERIALS AND METHODS: Sixty-six residents from seven residential homes in the Canton of Grisons, Switzerland were included. The sample was randomized to a treatment group that received comprehensive education about dental implants before the interview and a control group that received education after completing the questionnaire. RESULTS: The sample consisted of 54 women (81.8%) and 12 males (18.2%) with an average age of 86.2 years. Education before the interview did not show any impact on the attitude towards dental implants. Main reasons for a negative attitude towards implants were and high costs. Participants who received information about implants from their relatives and their own dentist and not from the study dentist were significantly more willing to receive implants. CONCLUSION: Providing an adequate education about benefits and risks of receiving dental implants does not change the attitude towards dental implants. The source of information/messenger does influence attitudes towards implants. If the person delivering the education and information is a relative or a known medical person, the person's attitude is more likely to change as compared to people receiving the information from an unrelated person.

9. Rignell L, Mikati M, Wertsen M, Hagglin C. Sedation with orally administered midazolam in elderly dental patients with major neurocognitive disorder. Gerodontology 2017 Sep;34(3):299-305. OBJECTIVE: The aim of this study was to evaluate acceptance of treatment after oral sedation with midazolam in dental patients with major neurocognitive disorder. BACKGROUND: Midazolam is commonly used as premedication in paediatric dentistry, oral surgery and people suffering from dental fear. Little is known about its use in other patient groups. METHODS: Dental and sedation records of 61 patients (64% women) sedated with midazolam were examined retrospectively. All records came from patients with major neurocognitive disorder who had been referred to a special dental care unit in Sweden due to uncooperative behaviour and sedated with orally administered midazolam between 2006 and 2011. Data concerning dose, degree of acceptance of dental treatment (four-point scale) and number of possible interacting drugs were collected from dental records. RESULTS: On average, the participants were 80 years old (range: 62-93) and used 3.4 possible interacting drugs. The average midazolam dose was 0.11 mg/kg body weight, which is in line with the regional medical guidelines for sedation. Twenty-seven participants (44%) had no cooperation problems when sedated, twenty-six (43%) were treated with minor adaptations, five had poor cooperation, and three were not possible to treat. No statistically significant differences were found for degree of acceptance of treatment and dose or number of possible interacting drugs. Antiepileptics were used by 13% (n=7) with

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good or quite good acceptance compared to 37% (n=3) among those with poor or no acceptance. Unfavourable side effects were rare; one participant became hyperactive and one drowsier than expected. CONCLUSION: Sedation with orally administered midazolam seems to be effective and safe in dental treatment of uncooperative persons with major neurocognitive disorder.

10. Dorfer C, Benz C, Aida J, Campard G. The relationship of oral health with general health and NCDs: a brief review. International Dental Journal 2017 Sep;67(Suppl 2):14-18. Oral health is closely related to systemic health. Periodontitis, a chronic inflammatory disease which is highly prevalent worldwide, interacts with a variety of noncommunicable diseases (NCDs). It is a risk factor in the complex pathogenesis of mellitus and and plays a role in the development of endocarditis and recurrent pneumonia in elderly people. However, the available data may be interpreted in different ways, and more and better-designed studies are still needed to answer relevant questions about the causal role of periodontitis in NCDs. What is clear is that periodontitis contributes to the systemic inflammatory burden. As periodontitis shares many common risk factors with NCDs, close collaboration between physicians and dentists is needed to increase the chance of early detection and improve the prevention and control of these conditions.

11. Muller F, Shimazaki Y, Kahabuka F, Schimmel M. Oral health for an ageing population: the importance of a natural dentition in older adults. International Dental Journal 2017 Sep;67(Suppl 2):7-13. Despite progress in dentistry, in old age is still a reality, even more so in long-term-care residents. However, recent trends indicate that natural teeth are lost later in life. Functional decline and age-related pathologies have to be considered in oral health care for this vulnerable population. Retaining and restoring teeth and oral function in elders is important. Tooth loss significantly impairs masticatory performance, which cannot be fully restored by prosthodontic means. Hence an unconscious change in food intake occurs, often involving malnutrition and withdrawal from common meals. Poor oral appearance and bad breath may further impede social activities. Although a chewing activity may be beneficial for cognitive function, natural teeth can present a considerable risk for fragile elders, in whom aspiration of biofilm can lead to pneumonia and death. The presence of natural teeth is also correlated with higher life expectancy, but socio-economic confounding factors have to be considered. When evaluating oral health in the elderly population, standards and priorities for reporting oral health outcome measures have to be defined. Anatomical indicators such as the number of natural teeth or the presence of prostheses might be one option for reporting. However, functional indicators such as masticatory performance and patient-centred outcome measures may be more relevant. In conclusion, there is an overwhelming body of evidence that maintaining a healthy natural dentition in old age is beneficial from a structural, functional and psycho-social point of view.

12. Ettinger RL, Goettsche ZS, Qian F. Postdoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools. Journal of Dental Education 2017 Oct;81(10):1220-1226.

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The aim of this study was to determine the number and size of postdoctoral teaching programs in geriatric dentistry in U.S. dental schools and other health professions educational institutions and those programs with Health Resources and Services Administration (HRSA) funding. In 2015, all 67 U.S. dental schools were contacted via email with a questionnaire to ask if they had a postdoctoral program in geriatric dentistry; if they did, they were asked to report the length and size of the program. Directors of all 16 HRSA-funded geriatric fellowships were also invited to participate in the survey. Fifty-six of the 67 (83.6%) dental schools and 15 of the 16 (93.8%) HRSA-funded programs completed the questionnaire. Postdoctoral geriatric dentistry programs were reported in 12 dental schools and six medical institutions, although only six programs were currently accepting fellows. The length of the programs was 12-36 months. The maximum number of residents in any program was ten. The oldest program was in Minnesota; it began in 1981. The newest program was beginning in 2017 at Boston University as a revised version of its previous HRSA-funded program. The loss of HRSA funding has had a major negative impact on the number of training programs. Future research is needed to determine how the loss of HRSA-funded programs has affected the availability of educators in geriatric dentistry for dental schools and the services provided to the geriatric community.

13. Amagai N, Komagamine Y, Kanazawa M, et al. The effect of prosthetic rehabilitation and simple dietary counseling on food intake and oral health related quality of life among the edentulous individuals: A randomized controlled trial. Journal of Dentistry 2017 Oct;65:89-94. OBJECTIVE: To investigate the combined effect of complete denture renewal and simple dietary advice. METHODS: A randomized controlled trial was performed with edentulous patients who required new complete . All participants received complete denture treatment. In addition, the intervention group received dietary advice in a pamphlet form, while the control group received advice pertaining to the care and maintenance of the dentures. The advice was given by dentists for each group. The participants' food intake was assessed at baseline and 3 months after intervention using a diet history questionnaire and an oral health related quality of life assessment measured using the Japanese version of the Oral Health Impact Profile for edentulous people (OHIP-EDENT-J). RESULTS: Among 70 participants who were randomized, 62 participants finished all parts of this trial. At baseline, there was no significant difference in the food intake between the two groups. At the 3-month assessment, the intervention group showed significantly greater intake of chicken (P=0.013), fish with bones (P=0.012), and carrots and pumpkins (P=0.025) compared to the control group. However, at baseline and at the 3-month assessment, there was no significant difference in the OHIP-EDENT-J scores between the groups, but the OHIP-EDENT-J scores significantly improved for both groups at the 3-month assessment. There were more significant improved dimensions of OHIP-EDENT-J in the intervention group than in the control group at the 3-month assessment. CONCLUSIONS: Simple dietary advice combined with complete denture treatment could improve food intake of edentulous patients. CLINICAL SIGNIFICANCE: The present study suggests that brief dietary advice provided by dentists can improve food intake of edentulous elderly. This simply diet advice is much easier compared to customized forms, might enable normal dentists provide patients it. The result of this study broadens possibility of nutritional counseling in daily clinical practice.

14. Marchini L, Hartshorn JE, Cowen H, Dawson DV, Johnsen DC. A Teaching Tool for Establishing Risk of Oral Health Deterioration in Elderly Patients: Development, Implementation, and Evaluation at a U.S. Dental School.

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Journal of Dental Education 2017 Nov;81(11):1283-1290. The aim of this study was to develop and evaluate a learning strategy using critical thinking to teach dental students how to assess the risk of rapid oral health deterioration (ROHD) among elderly patients. A learning guide was developed using risk factors identified in the literature and the steps that expert faculty members apply in their clinical decision making, summarized in a set of ten steps. A new system of labeling risk was developed for the elderly population, which correlates the level of risk with the amount of disease. Participants in the study were all 91 fourth-year dental students in two subsequent classes who took part in a five-week Geriatrics and Special Needs Clinic rotation in the spring of 2015 and 2016. The students were introduced to the ROHD concept and asked to use the guide in a presentation during their rotation. The students were graded on an A, G, or M scale (Applied concept, Grasped and applied concept, or Missed application of concept). Students were also asked to assess their learning experience, and their answers were thematically grouped and analyzed. For eight of the ten steps, at least 93% of the students were graded A or G. The exceptions were the steps about developing a communications plan, which was missed by 23.1%, and self-assessment, which was missed by 30.8%. Interexaminer agreement on students' applying (A + G grades) versus missing the step was moderate or high on six of ten items. Nearly all the students (98.7%) considered assessing the risk of ROHD an important or very important skill. In this study, a learning strategy to teach dental students how to assess the risk of ROHD among elderly patients was developed and successfully implemented.

15. Northridge ME, Schenkel AB, Birenz S, Estrada I, Metcalf SS, Wolff MS. "You Get Beautiful Teeth Down There": Racial/Ethnic Minority Older Adults' Perspectives on Care at Dental School Clinics. Journal of Dental Education 2017 Nov;81(11):1273-1282. To help eliminate reported racial/ethnic and socioeconomic inequities in oral health care, listening to the perspectives of racial/ethnic minority older adults on their experiences with dental school clinics is needed. The aim of this study was to examine the experiences of African American, Puerto Rican, and Dominican older adults who attend senior centers in upper Manhattan, New York City, regarding the care received at dental school clinics. Focus groups were conducted from 2013 to 2015 with 194 racial/ethnic minority men and women aged 50 years and older living in upper Manhattan. All of the 24 focus group sessions were digitally audiorecorded and transcribed for analysis. Groups conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Seven subthemes were manifest in the data related to these adults' positive experiences with dental school clinics: excellent outcomes and dentists, painless and safe treatment, affordable care, honest and reputable, benefits of student training, accepting and helpful, and recommended by family and friends. Negative experiences centered around four subthemes: multiple visits required for treatment, loss of interpersonal communication due to use of technology, inconvenient location, and perceived stigma with Medicaid. This study provided novel evidence of the largely positive experiences with dental schools of racial/ethnic minority senior center attendees. Interventions targeted at the organization and provider level, including organizational motivation, resources, staff attributes, climate, and teamwork plus payment programs and services, insurance and affordability, and provider- and system-level supports, may improve health care processes and patient experiences of care.

16. Polyzois G, Lagouvardos P, Omar R, Brunton P. Attitudes of dentists toward denture adhesives: A questionnaire survey in Greece. Journal of Prosthetic Dentistry 2017 Nov;118(5):643-649. STATEMENT OF PROBLEM: The attitudes of dental professionals toward denture adhesives (DAs) require further investigation.

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PURPOSE: The purpose of this survey was to assess the attitudes of dentists in Greece toward DAs and the possible effects of sex, age, training, and awareness level on these attitudes. MATERIAL AND METHODS: An 18-item questionnaire in the Greek language concerning the use of DAs by dentists in the metropolitan area of Athens, Greece was distributed on line. Its URL address was emailed to 793 randomly chosen dentists in the area, 438 of whom filled out and submitted a valid questionnaire (55.2% response rate). Data for each item were statistically analyzed for their associations with sex, age, training, and awareness level by the chi-square test for independence (alpha=.05). RESULTS: The results showed that 61.5% of general practitioners and 49% of specialist prosthodontists recommend the use of DAs. Their continuous use was recommended most frequently (46.9%), mainly in the cream form (93.8%). Their use was recommended not only for patients wearing older dentures (60.2%) but also for patients with newly fabricated ones (61.9%) to assist their adaptation to dentures (42.2%). Associations were found between a few only items and sex (Q07, Q11a,b), age (Q13), training (Q11q,b), and awareness level (Q11a,b,d,e) (P<.05). CONCLUSIONS: This survey shows that in the metropolitan area of Athens, Greece, a significant proportion of dentists (60.3%) recommend the use of DAs and do so more often as a continuous regimen for both existing and new denture wearers. Sex, age, training, and awareness level proved to be factors affecting only a few dentists' attitudes.

17. Skaar DD, H OC. Using the Beers criteria to identify potentially inappropriate medication use by older adult dental patients. Journal of the American Dental Association 2017 May;148(5):298-307. BACKGROUND: An aging population indicates that increasing numbers of older adults will seek oral health care and have multiple chronic conditions treated with a number of medications. The authors examined the Medicare Current Beneficiary Survey administrative data set to characterize potentially inappropriate medication (PIM) use by older adults visiting the dentist and related adverse experiences that may affect oral health care. METHODS: The authors used the 2015 Beers criteria to identify PIMs for older adults. The authors examined the Medicare Current Beneficiary Survey administrative data set for community-dwelling older adults with dental care visits and reported national prevalence estimates of Beers criteria medication prescribing. The authors used logistic regression to identify sociodemographic and health-related characteristics associated with potentially inappropriate prescribing. The authors described medication-related adverse experiences affecting dental care. RESULTS: Among older adults with dental care visits, 56.9% received a prescription for at least 1 Beers criteria medication, and 28.3% received a prescription for 2 or more Beers criteria medications. Beers criteria medication use was associated most strongly with the number of comorbid diseases as represented by higher Charlson Index scores (odds ratios, > 1.0). CONCLUSIONS: A substantial proportion of community-dwelling older adults visiting dentists had received prescriptions for 1 or more potentially age- inappropriate Beers criteria medications. Many of these medications have adverse effects that could affect patient safety and oral health care. PRACTICAL IMPLICATIONS: These results support the need for clinicians to be aware of PIM use by older adults, recognize associated medication-related adverse events, and avoid prescribing age-inappropriate medications to this vulnerable patient population. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

18. Ardenghi DM, Wyatt C.

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Exploring the views of relatives of frail elderly patients about participating in a geriatric dentistry program. Special Care in Dentistry 2017 May;37(3):140-146. Elderly residents of long-term care facilities (LTC) have difficulty accessing dental services. Aiming to improve access for this population, the Geriatric Dental Program (GDP) was established by UBC Faculty of Dentistry in 2002. Within the GDP, elderly people receive fee-for-service dental care. The objective of this research was to explore whether accessing these services had an impact on the lives of the patients' relatives. Data was collected through semi-structured, face-to-face, audio-recorded interviews with family members of 12 GDP patients. A criterion sampling method was used to select the interviewed family. Interview transcription and data coding procedures were conducted following Saldana. NVivo software was used to code and organize the transcripts. Data analysis followed a qualitative thematic analysis. Final analysis shows that patient relatives are worried about their relatives' oral health. They believe that it is difficult to find private dentists with geriatric expertise and to make appointments for their family members in private practice. In addition, they report that the GDP made their life less stressful and relieved the burden of setting up appointments for their relatives. Thus, it is expected that a similar program may positively affect the lives of patient relatives by improving access to dental care services. Copyright © 2017 Special Care Dentistry Association and Wiley Periodicals, Inc.

19. Krug R, Krastl G, Jahreis M. Technical quality of a matching-taper single-cone filling technique following rotary instrumentation compared with lateral compaction after manual preparation: a retrospective study. Clinical Oral Investigations 2017 Mar;21(2):643-652. OBJECTIVES: The objectives of the study were to evaluate the radiographic technical quality of before and after the implementation of a nickel-titanium rotary (NiTiR) preparation followed by a matching-taper single-cone (mSC) obturation and to detect the procedural errors associated with this technique. MATERIALS AND METHODS: A random sample of 535 patients received root canal treatment at the Department of and at the University of Wurzburg: 254 teeth were treated in 2002-2003 by using stainless steel instruments (SSI) for preparation and a lateral compaction (LC) technique (classic group (CG)). Two hundred eighty-one teeth were root filled in 2012-2013 employing NiTiR instruments for the root canal shaping and a mSC technique (advanced group (AG)). The quality assessments were based on the radiographic criteria of the European Society of Endodontology. The presence of voids was recorded separately for the apical, central and cervical thirds of the root canals. Procedural errors, such as ledges, apical transportations, perforations and fractured instruments, were detected. The root canal fillings in the CG and AG were compared using chi- squared and Fisher's exact tests. Multivariable logistic regression was performed to investigate the association between the independent variables (patient age, tooth type and type of treatment) and the dependent variables (density and length). RESULTS: Adequate length was achieved significantly more often in the AG compared to the CG for molars (p = 0.017), mandibular teeth (p = 0.013) and primary root canal treatments (p = 0.024). No significant difference was detected between the AG and CG regarding adequate length in general (p = 0.051) or adequate overall quality of root canal filling (p = 0.1). In the AG, a significant decrease in procedural errors was evident (p = 0.019) and decreases in the densities of the root canal fillings in the cervical (p = 0.01) and central (p = 0.01) thirds of the root canals were also observed. Moreover, root canals in elderly patients exhibited fewer voids (p = 0.009). CONCLUSIONS: Rotary root canal preparation followed by a matching-taper single-cone filling technique provides a reliable shaping of the root canal, with fewer procedural errors and a more acceptable filling quality in terms of length and homogeneity in the apical third. Less favourable results were achieved in

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the central and cervical parts of the root canals. CLINICAL RELEVANCE: The matching-taper single-cone technique seems to effectively obturate well-tapered root canals after adequate rotary instrumentation. Irregularly shaped canals require additional lateral or warm vertical condensation to avoid voids.

20. Barbe AG, Bock N, Derman SH, Felsch M, Timmermann L, Noack MJ. Self-assessment of oral health, dental health care and oral health-related quality of life among Parkinson's disease patients. Gerodontology 2017 Mar;34(1):135-143. OBJECTIVE: Parkinson's disease (PD) is a common condition in elderly people and can adversely affect oral health (OH). However, the subjective burden of oral symptoms on the quality of life (QoL) of patients with PD is largely unknown and needs to be better understood. The objective of this study was to explore self-assessed dental care in patients with PD, including the ability to perform oral hygiene, self-assessed , drooling and dysphagia problems, and the impact on OH-related QoL. MATERIALS AND METHODS: A questionnaire was completed by 100 patients with PD in Germany recruited from PD support groups, and included self- assessment of dental care, the Oral Health Impact Profile (OHIP-14) score, the levodopa equivalent daily dose, the Movement Disorder Society Unified Parkinson's Disease Rating Scale-II and the leading OH-related symptoms. RESULTS: Participants experienced xerostomia (49%), drooling (70%) and dysphagia (47%) and suffered from a limited ability to perform oral hygiene (29%). The oral symptoms xerostomia, drooling and dysphagia impaired the OH-related QoL [OHIP total score 14.6 (9.7)-16.8 (11.4) compared to 11.3 (9.9) in participants without symptoms]. In total, 91.8% of participants had their own dentist. Only 6.1% of participants with xerostomia received advice regarding management. CONCLUSION: In this study, patients with PD suffered from OH-related symptoms (xerostomia, drooling, and dysphagia) that impaired their OH-related QoL. Participants felt that they received adequate dental health care; however, dental advice regarding management of PD-related OH problems was often lacking. Copyright © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

21. Shah V, Rao J, Verma V, Singh K, Agarwal B. Invasive fungal rhinosinusitis with palatal erosion in an elderly edentulous patient with uncontrolled diabetes: report of a rare case. Gerodontology 2017 Mar;34(1):144-146. OBJECTIVES: To report a rare case of chronic invasive fungal rhinosinusitis with palatal erosion. BACKGROUND: Restoring and maintaining oral health of diabetic elderly patients with increased risk of infections is a challenge to the dentist. Patients suffering from uncontrolled diabetes are susceptible to fungal infections. Palatal erosion due to fungal rhinosinusitis is rare. MATERIALS AND METHODS: Case report of a 65 years old illiterate female patient from low socio-economic strata, suffering from uncontrolled diabetes and poor systemic health presenting with chronic invasive fungal rhinosinusitis leading to palatal erosion. CONCLUSION: Such a case is a diagnostic challenge to a dentist. Therefore understanding the disease process and its possible outcomes is desirable. The treatment warrants a multidisciplinary approach. Copyright © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

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22. Smith MB, Thomson WM. 'Not on the radar': dentists' perspectives on the oral health care of dependent older people. Gerodontology 2017 Mar;34(1):90-100. OBJECTIVES: We explored the following research questions: (i) what challenges do dentists face when providing oral health care to dependent older adults; and (ii) to overcome those challenges, what recommendations would dentists providing care give those planning and implementing oral health policy and services for dependent older adults? BACKGROUND: The dentate older population is steadily increasing, and about half will end up in residential care, where dental caries rates over time are at least twice as great as those observed elsewhere. MATERIALS AND METHODS: A qualitative study was used, with semi-structured interviews conducted by a single interviewer. Dental examiners in a recent national survey of oral health in dependent older people in New Zealand were interviewed about their experiences and perspectives of that. RESULTS: The challenges participants identified stemmed from three areas - the patient, the care facility and the oral health sector. To address those challenges, the participants recommended actions at the patient, system and sector levels. Each of the challenges and recommendations had a number of subthemes. Overall, the dentists felt that it is a very complex situation urgently requiring policy development, cross-sectoral collaboration and upskilling of the dental profession, carers, the private sector and the State to ensure a care environment which supports achieving and maintaining oral health among frail elders. CONCLUSIONS: Urgent attention to frail older New Zealanders' oral health is needed. Such attention needs to focus on not only the narrow dental clinical preventive and therapeutic implications of those needs, but also on the broader health system and policy development challenges. Copyright © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

23. Roberts RM, Bartoces M, Thompson SE, Hicks LA. Antibiotic prescribing by general dentists in the United States, 2013. Journal of the American Dental Association 2017 Mar;148(3):172-178.e1. BACKGROUND: Dentists prescribe approximately 10% of outpatient antibiotics, but little is known about dentists' antibiotic prescribing patterns. The authors conducted a study to characterize prescribing by dentists according to antibiotic agent and category, patient demographic characteristics, and geographic region in the United States. METHODS: The authors identified oral antibiotic prescriptions dispensed during 2013 in the Xponent (QuintilesIMS) database. The authors used the total number of prescriptions and county-level census population denominators to calculate prescribing rates. In addition, the authors analyzed prescribing according to individual agent, drug category, and patient demographic characteristics and the total number of prescriptions calculated for general dentists overall. RESULTS: Dentists prescribed 24.5 million courses of antibiotics in 2013, a prescribing rate of 77.5 prescriptions per 1,000 people. Penicillins were the most commonly prescribed antibiotic category. Dentists prescribed most antibiotics for adults older than 19 years. The Northeast census region had the highest prescribing rate per 1,000 people. The District of Columbia had the highest prescribing rate of 99.5 per 1,000 people, and Delaware had the lowest prescribing rate of 50.7 per 1,000 people. CONCLUSIONS: Dentists prescribe large quantities of antibiotics in outpatient settings, and there is considerable geographic variability. Additional study is

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needed to better understand the reasons for this variability and identify areas of possible intervention and improvement. PRACTICAL IMPLICATIONS: Continued efforts to combat antibiotic resistance will require all prescribers, including dentists, to examine prescribing behaviors for appropriateness and the effectiveness of guidelines to identify opportunities to optimize antibiotic use. Copyright Published by Elsevier Inc.

24. Wostmann B, Seelbach M, Seelbach P, et al. Mini dental assessment: a simple screening test for non-dental staff. Clinical Oral Investigations 2017 Jun;21(5):1457-1464. OBJECTIVE: The objective of this study was to develop a simple tool for the assessment of possible dental treatment needs (DTN) for non-dental professionals (Mini Dental Assessment, MDA). To keep the assessment universal, we aimed to base it on the patient's history and a simple chewing efficiency test (CET) as the dental status is a known determinant for chewing efficiency. MATERIALS & METHODS: The assessment was developed using data from 169 patients from two sites (University Hospital Giessen, St. Bonifatius Hospital Lingen, both Germany). In all patients, a dental examination was performed, the denture status was evaluated (based on the California Dental Association criteria; CDA criteria), and the DTN was determined. In addition, the time since the patient's last visit to a dentist (TLVD) and denture age (DA) were assessed. Furthermore, a CET was carried out and the comminution score was determined (CETS). RESULTS: In total, 108 patients required dental treatment. The mean value (+/-SD) was 2.9 +/- 0.9 score points for the DTN, 2.5 +/- 3.8 years for the TLVD, and 10.8 +/- 8.9 years for the DA. There was a significant correlation (Spearman, P < .05) between the DTN and degree of comminution (3.4 +/- 1.8). Based on the results of the statistical analysis, the intended assessment tool was developed using the variables CETS, TLVD, and DA weighed by their respective regression coefficients (10:3:1). Subsequently, the resulting MDA score (51.32 +/- 28.14) was calculated. A sensitivity/specificity analysis was conducted and a receiver operating characteristic curve was calculated (SPSS 17.0, area under curve 0.805; 95 % CI 0.738-0.873). CONCLUSION: It can be concluded that the dental status of elderly patients is reflected in the outcome of the MDA. However, ongoing validation is needed. Trial registration: drks00003219.

25. Ju X, Spencer AJ, Brennan DS. Dentist age, period and cohort effects on provision of dental services in Australia: 1983-84 to 2009-10. Community Dentistry & Oral Epidemiology 2017 Jun;45(3):242-250. OBJECTIVE: To examine age, period and cohort factors of dentists in relation to diagnostic, preventive and total dental services over time in Australia. METHOD: The Longitudinal Study of Dentists' Practice Activity (LSDPA) was designed to monitor dental practice activity and service provision in Australia. Participating dentists were sampled randomly from the dental registers in Australia from 1983 to 1984, and dental services provision was collected by mailed questionnaire with a log of dental services provided over one or two typical days. The data collection has been repeated every 5 years until 2009-2010. Sample supplementation of newly registered dentists occurred at successive waves. This study focused on diagnostic, preventive and total services. The time trends in the mean rates of the services were described using a standard cohort table, and negative binomial regression was applied to estimate age, period and cohort effects. RESULTS: The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The mean rates of

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diagnostic, preventive and total services increased between 1983 and 2009 across all age groups. The period effect showed a higher rate of diagnostic (rate ratios [RR]: 1.21 in 1993 to 1.80 in 2009), preventive (RR: 1.19 in 1988 to 1.85 in 2009) and the total service (RR: 1.08 in 1988 to 1.39 in 2009) over time, compared with the reference group of 1983. Older cohorts had a lower rate, and the younger cohorts had a higher rate of diagnostic, preventive and the total number of services over the study period. The highest rate of diagnostic (RR=2.53), preventive (RR=2.44) and the total service (RR=1.52) was in those aged 25-29 years in 1983 compared with the reference group of 30-34 years in 1983. CONCLUSIONS: Trends in dental services provision can be associated with age, period and cohort effects. The study found the rate of diagnostic, preventive and total services increased over time. Meanwhile, an increasing rate of diagnostic, preventive and the total services was observed when moving from older cohorts to younger cohorts among Australian dentists suggesting a sustained shift towards these services into the future. Copyright © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

26. Kiefner P, Connert T, ElAyouti A, Weiger R. Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up. Gerodontology 2017 Jun;34(2):164-170. OBJECTIVE: Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to . BACKGROUND: Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population. MATERIALS AND METHODS: Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured. RESULTS: All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min. CONCLUSION: Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%. Copyright © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

27. Lain R, Ajwani S. Minor post-extraction complications other than BRONJ in older patients on oral bisphosphonates - a retrospective study. Gerodontology 2017 Jun;34(2):171-179. BACKGROUND: Oral bisphosphonates (BP) have been prescribed widely in patients. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been reported as a major complication, but there is little information about minor complications. OBJECTIVE: This retrospective study describes post-operative complications - other than BRONJ - associated with dental extractions in patients on oral BP

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and compares outcomes with patients not on oral BP. METHODS: The study period was 2004-05 ending December 2005, prior to the introduction of protocols for minimising risks related to extractions in patients on BP therapy. Records of patients aged 60 years and over who underwent extractions during this period at Sydney Dental Hospital were examined and post- operative complications analysed. RESULTS: There were 266 participants identified on oral BP therapy out of an available number of 3811 available files based retrospectively from records of 4126 participants who underwent extractions during the two-year period. In the oral BP group, 10% had complications compared with 2% in the non-oral BP group (p < 0.0001). This relationship remained significant even after adjusting for age, gender, operator, type and site of procedure. Delayed healing (36%) and exposed alveolar bone which required an intervention (31%) were the most common complications in the BP group. CONCLUSION: The prevalence of minor post-operative complications among BP participants was significantly higher than in non-BP participants. The nature of the complications was in the range of pathology familiar to - and treatable by - the general dentist. Copyright © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

28. Yanagi A, Murase M, Sumita YI, Taniguchi H. Investigation of nutritional status using the Mini Nutritional Assessment-Short Form and analysis of the relevant factors in patients with head and neck tumour. Gerodontology 2017 Jun;34(2):227-231. OBJECTIVE: The aims of this study were to reveal the nutritional status of patients after head and neck tumour treatment by using the Mini Nutritional Assessment-Short Form (MNA-SF) and to analyse the factors affecting nutritional status in patients with head and neck tumour. BACKGROUND: Elderly patients with loss of teeth and maxillary/mandibular bone due to head and neck tumour treatment could be at high risk of malnutrition. However, there are few reports on the nutritional status of these patients. MATERIALS AND METHODS: Forty-six participants (average age 74.7 years) were selected from patients who visited the maxillofacial prosthetics clinic of Tokyo Medical and Dental University Hospital Faculty of Dentistry in Japan. Nutritional status was evaluated using the MNA-SF. Multiple regression analysis was used to identify predictors affecting MNA-SF score. The candidate explanatory variables were age, sex, maxillofacial prosthesis use, number of residual teeth, resection side, neck dissection and treatment option. RESULTS: The results showed that approximately half of the patients were at risk of malnutrition, and a regression equation for MNA-SF score was developed using two predictors: maxillofacial prosthesis use and neck dissection. CONCLUSION: Use of a maxillofacial prosthesis can improve nutritional status. On the other hand, a medical history of neck dissection can decrease nutritional status. Copyright © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

29. Friedlander AH, Graves LL, Grabich SG, Aghazadehsanai N, Chang TI. Prevalence of calcified carotid artery atheromas on panoramic images of older men with gout: a descriptive retrospective study. Dento-Maxillo-Facial Radiology 2017 Jul;46(5):20160406. OBJECTIVES: Given the enhanced risk of ischaemic resulting from the direct effects of hyperuricaemia on vascular plaque formation seen among older males with gout, we sought to determine the prevalence of calcified carotid artery atheromas (CCAAs) on their panoramic images (PIs).

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METHODS: Medical record librarians identified all male patients over 45 years, who had a diagnosis of gout and a PI incidentally obtained between 2000 and 2015. The prevalence rate of CCAA on technically appropriate images was determined, as were these patients' atherogenic risk profiles including: age, body mass index, and dyslipidaemia. Comparisons of atherogenic risk factors were made between this cohort and those without CCAA. RESULTS: Of the 531 patients with gout, 163 patients were adjudicated to be CCAA+ (the panoramic image demonstrates a calcified carotid artery atheroma). Logistic regression analysis demonstrated that a comorbid diagnosis of diabetes mellitus or dyslipidaemia, or advancing age was determinant in differentiating patients who were CCAA+ vs those who were CCAA- (the panoramic image does not demonstrate a calcified carotid artery atheroma). CONCLUSIONS: CCAAs often herald an ischaemic stroke and may be seen on the PIs of patients with gout, especially those with increased age, dyslipidaemia or diabetes. Thus, dentists must be uniquely vigilant in detecting these lesions when evaluating the images of all patients with gout, especially those with additional positive risk factors.

30. Andjelkovic M, Sojic LT, Lemic AM, Nikolic N, Kannosh IY, Milasin J. Does the Prevalence of Periodontal Pathogens Change in Elderly Edentulous Patients after Complete Denture Treatment? Journal of 2017 Jul;26(5):364-369. PURPOSE: To determine if wearing complete dentures can cause changes in prevalence of some of the most common periodontal pathogens in elderly edentulous patients. The need for understanding the composition of oral microflora in edentulous patients has been recognized by some authors, but no studies have dealt with the changes that occur in periodontal pathogens' prevalence as a result of complete dentures. MATERIALS AND METHODS: A total of 30 edentulous elderly (average age 71) patients participated in the study. Complete dentures were fabricated for each patient, and the residual alveolar ridges were swabbed before denture insertion. After a period of 6 months swabs were taken again. Identification of P. intermedia, A. actinomycetemcomitans, P. gingivalis, T. forsythia, T. denticola, and F. nucleatum was done by the polymerase chain reaction (PCR) method and primers specific for each microorganism. RESULTS: A noticeable increase in the presence of periodontal pathogens was observed after 6 months of denture wearing; targeted bacteria were identified in 17 pre-insertion samples compared to 28 post-insertion samples. The McNemar test was used to compare the prevalence of periodontal pathogenic bacteria before and after dental treatment. p<0.05 indicated statistical significance. Three microorganisms showed a statistically significant difference between the first and second swabbing-A. actinomycetemcomitans (6.7% vs. 40.0%, p = 0.006), P. intermedia (30.0% vs. 73.3%, p = 0.004), and T. forsythia (6.7% vs. 30.0%, p = 0.004). There was also an increase in bacteria co-associations 6 months post-insertion of complete dentures. CONCLUSIONS: The results of the present study suggested that wearing complete dentures caused a considerable increase of periodontopathic bacteria prevalence in elderly patients. Better understanding of oral microflora and the impact dental treatment has on bacterial colonies is important in modern dentistry.

31. Schimmel M, Muller F, Suter V, Buser D. Implants for elderly patients. Periodontology 2000 2017 Feb;73(1):228-240. In the developed world, the large birth cohorts of the so-called baby boomer generation have arrived in medical and dental practices. Often, elderly patients are 'young-old' baby boomers in whom partial edentulism is the predominant indication for implant therapy. However, the generation 85+ years of age

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represents a new challenge for the dental profession, as their lives are frequently dominated by dependency, multimorbidity and frailty. In geriatric implant dentistry, treatment planning is highly individualized, as interindividual differences become more pronounced with age. Nevertheless, there are four typical indications for implant therapy: (i) avoidance of removable partial prostheses; (ii) preservation of existing removable partial prostheses; (iii) stabilization of Kennedy Class I removable partial prostheses; and (iv) stabilization of complete prostheses. From a surgical point of view, two very important aspects must be considered when planning implant surgery in elderly patients: first, the consistent strive to minimize morbidity; and, second, the fact that coexisting medical risk factors are significantly more common in elderly patients. Modern three-dimensional cone beam computed tomography imaging is often indicated in order to plan minimally invasive implant surgery. Computer-assisted implant surgery might allow flapless implant surgery, which offers a low level of postoperative morbidity and a minimal risk of postsurgical bleeding. Short and reduced-diameter implants are now utilized much more often than a decade ago. Two-stage surgical procedures should be avoided in elderly patients. Implant restorations for elderly patients should be designed so that they can be modified to become low-maintenance prostheses, or even be removed, as a strategy to facilitate oral hygiene and comfort in the final stage of life. Copyright © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

32. Andersson P, Renvert S, Sjogren P, Zimmerman M. Dental status in nursing home residents with domiciliary dental care in Sweden. Community Dental Health 2017 Dec 01;34(4):203-207. OBJECTIVE: To describe the dental health status of elderly people in nursing homes receiving domiciliary dental care. DESIGN: Case note review. CLINICAL SETTING: Nursing homes in 8 Swedish counties. PARTICIPANTS: Care dependent elderly people (>=65 years). METHODS: Clinical data, including the number of remaining natural teeth, missing and decayed teeth (manifest dental caries) and root remnants, recorded by dentists according to standard practices. Medical and dental risk assessments were performed. RESULTS: Data were available for 20,664 patients. Most were women (69.1%), with a mean age of 87.1 years (SD 7.42, range 65-109). The mean age for men was 83.5 years (SD 8.12, range 65-105). Two or more medical conditions were present in most of the population. A total of 16,210 individuals had existing teeth of whom 10,974 (67.7%) had manifest caries. The mean number of teeth with caries was 5.0 (SD 5.93) corresponding to 22.8% of existing teeth. One in four individuals were considered to have a very high risk in at least one professional dental risk assessment category. CONCLUSIONS: Care dependent elderly in nursing homes have very poor oral health. There is a need to focus on the oral health-related quality of life for this group of frail elderly during their final period of life.

33. Suzuki R. The interaction effects between race and functional disabilities on the prevalence of self-reported periodontal diseases - National Health and Nutrition Examination Survey 2011-2012. Community Dental Health 2017 Dec 01;34(4):234-240. BACKGROUND: Racial minority groups and adults with functional disabilities (FDs) disproportionally experience periodontal diseases. However, little is known about the interactions of these two characteristics in disease prevalence. The purpose of this study was to examine the association between FDs and

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periodontal experiences, and to identify whether race has a particular influence on this relationship. METHODS: Data were derived from the National Health and Nutrition Examination Survey 2011-2012, in a representative sample of adults aged 30 years and older. FDs were defined as experiencing limitations in activities of daily living. The weighted logistic regression models were performed using SAS software. RESULTS: The incidence of FDs was associated with a poor self-rated perception of teeth and gum health, gum disease, bone loss, and loss of teeth. The racial minority groups with FDs were more likely to report poor teeth and gum health, loose teeth, and a history of gum disease treatment. Mexican Americans with FDs reported poor teeth and gum health, gum disease, and had been previously treated for gum disease. African Americans with FDs were more likely to be diagnosed with bone loss and loose teeth. PRACTICAL IMPLICATIONS: Racial minority groups with FDs were more likely to be associated with and poor oral health. To improve oral health, access to dental care among minority populations is important, particularly for people with FDs in community settings. Dentists should reach out to these underrepresented groups to address their oral health needs.

34. Conquest JH, Skinner J, Kruger E, Tennant M. Dental care for the elderly through a Capped-fee funding model: Optimising outcomes for primary government dental services. Gerodontology 2017 Dec;34(4):486-492. OBJECTIVE: The objectives of this study were to (i) compare a Capped Payment formula for adults, to the fee-for-service model and the New South Wales Government services payment model; (ii) identify the presenting oral health needs of a 65+ years of age cohort during the period January 2011 to March 2015. BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD: Australia faces an ageing population with the vast majority accessing free market dental care, whilst the poor access Government services. This cohort retains most of their dentition increasing demand on Government services. MATERIALS AND METHODS: The analysis of New South Wales Government adult de-identified patients' record unit data was from 2011 to 2015, for the three payment models and undertaken in three stages; (i) development of the Capped Payment Model; (ii) evaluation of twenty (20) case studies of adults 65+ years of age; (iii) analyse the cost efficiency of the three payment models. RESULTS: This study found that the Government model was the most cost effective. The Capped-fee model performed less efficiently, particularly in the 75+ age group, with the fee-for-service model generally more costly. It was $2580 (85%) more costly for the 65-74 age cohort, and $4619 (66%) for the 75+ age cohort. CONCLUSION: Policy makers in partnership with Government and private service providers should seek to develop partnerships with Government, private services and universities, scope opportunities in applying a Capped-fee funding model, and one that helps address the oral needs of the elderly.

35. Walsh LJ. Minimal intervention management of the older patient. British Dental Journal 2017 Aug 11;223(3):151-161. With an aging population, dentists need to be aware of the risks which come to their elderly patients from retained teeth and exposed root surfaces. Oral health problems in the later years of life are multifactorial, with lifestyle, plaque and salivary factors remaining paramount. Root surface caries is likely to

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present a challenge in patients with a strong history of past coronal caries (and who have the attendant lifestyle risk factors) as well as in elderly patients who suddenly develop salivary hypofunction. Following a maximum interception approach means that specific efforts are needed to profile salivary, plaque and lifestyle risk factors and ensure that the dentition can be cleaned by the patient and maintained in a way which gives comfort and function as well as aesthetics. Discussions around long-term objectives for oral health are important when there is a sudden decline in general health in the later years of life. It may be appropriate to use tooth surface protection for strategic anterior teeth and apply the shortened dental arch concept where patients cannot readily maintain their own oral health because of frailty or medical conditions. Glass ionomer materials can be used both for root surface protection and for conservative restoration where a minimally invasive preparation has been undertaken. In other cases, arrest of lesions using silver fluoride or CPP-ACP topical treatments can delay or obviate the need for restorative interventions, and forms part of the management of patients in high care units in nursing homes. Involving all members of the healthcare team in supporting oral health is an important strategy to ensure that oral health issues are not overlooked. The challenge is to promote evidence-based self-care. A key message is to promote oral health as part of overall health.

36. Giannakopoulos NN, Ariaans K, Eberhard L, Klotz AL, Oh K, Kappel S. Immediate and delayed loading of two-piece reduced-diameter implants with locator-analog attachments in edentulous mandibles: One-year results from a randomized clinical trial examining clinical outcome and patient expectation. Clinical Implant Dentistry & Related Research 2017 Aug;19(4):643-653. BACKGROUND: Prosthetic management of thin alveolar ridges in the edentulous mandibles of elderly patients, especially the time of loading, the number of implants needed, and patient expectations and perception, is a challenge in implant dentistry. PURPOSE: Survival of conventionally and immediately loaded 2-piece reduced-diameter implants in the interforaminal region of the edentulous mandible supporting locator-analog attachments was evaluated. Prosthetic complications and peri-implant hygiene were also studied, and patient expectation and subjective evaluation of the treatment were documented. MATERIAL AND METHODS: Twenty-five patients with adapted complete dentures received 4 reduced-diameter implants. All anterior implants were immediately loaded. Three months later, patients were allocated by randomization to 1 of 2 treatment groups: 2 locator-analog attachments on the anterior implants (Group A); or 4 locator-analog attachments (Group B). After another 3 months patient allocation was changed (crossover design) for the next 3 months. Questionnaires with Likert scales and numeric rating scales were used to assess patients' expectations and subjective overdenture-related variables, respectively. RESULTS: One implant was lost in the immediate-loading group. Survival was 98% and 100% for immediate and delayed loading, respectively. During 12- month observation, 8 complications required aftercare. At the beginning of treatment, patients' expectations were highly positive. Subjective assessment of overdenture-related variables 3 months after immediate loading of 2 implants revealed a statistically significant improvement for most of the variables studied; this was maintained 1 year later. In the subjective assessments, there were no statistically significant differences between Groups A and B. CONCLUSION: Immediate loading of reduced-diameter implants supporting locator-analog attachments resulted in high implant survival, few prosthetic complications, good oral hygiene, and improvement of subjective denture perception in the short-term. It might be a promising treatment option, especially for elderly patients with a narrow mandibular ridge.

37. Ettinger RL, Goettsche ZS, Qian F.

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Predoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools. Journal of Dental Education 2017 Aug;81(8):921-928. The aim of this study was to assess the current teaching of geriatric dentistry in U.S. dental schools and compare the findings to previous reports. Academic deans at all 67 U.S. dental schools were contacted in November 2015 via email, asking them to complete a questionnaire about the teaching of geriatric dentistry or gerodontology at their institution. Questionnaires were received from 56 of the 67 schools (84% response rate). The results showed that geriatric dentistry was taught in all responding schools; for 92.8% of the respondents, the instruction was compulsory. Among the responding schools, 62.5% were teaching it as an independent course, 25% as an organized series of lectures, and 8.9% as occasional lectures in parts of other courses. In addition, 57.1% had some form of compulsory clinical education in geriatric dentistry. Public schools, as opposed to private schools, were marginally associated with an increased interest in expanding geriatric dentistry teaching (p=0.078). No differences were found between any teaching variables and school location. This study found that the form of education in geriatric dentistry in U.S. dental schools differed in many ways, but the teaching of geriatric dentistry had increased among all respondents and had been increasing for over 30 years. Future research is needed to determine the impact of this teaching on services to the geriatric community.

38. Marshall TA, Marchini L, Cowen H, et al. Critical Thinking Theory to Practice: Using the Expert's Thought Process as Guide for Learning and Assessment. Journal of Dental Education 2017 Aug;81(8):978-985. Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.

39. Weintraub JA. What Should Oral Health Professionals Know in 2040: Executive Summary. Journal of Dental Education 2017 Aug;81(8):1024-1032. The "Advancing Dental Education in the 21st Century" project assesses current status and trends to prepare for the future. Section 3 of the project asks what knowledge and skills should dental and advanced dental education learners have to provide dental care in 2040 and how should educators be preparing them. This executive summary of five background articles in this section focuses on predoctoral education, advanced dental education, the provision of medical services within dental practice, the incorporation of oral health services into primary care and medical practice, and interprofessional education and practice. The changing environment and external forces are presented along with their implications for advancing dental education. These

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forces include changes in population characteristics (e.g., demographics, disease prevalence, health disparities, consumerism), treatment needs and modalities, care delivery, science and technology, educational methods, and medical and dental integration. Future oral health professionals (OHPs) will care for more diverse patient populations, older patients with complex medical and dental needs, and relatively dentally healthy younger cohorts who require fewer complex restorative and prosthodontic treatments. Increasing integration of medical and oral health education and patient care will require OHPs to have more medical knowledge and to practice in intra- and interprofessional teams. OHPs increasingly will be providing patient-centered care as employees in large group practices, health care settings, and safety net clinics with expanded types of OHPs and improved materials and technology. Educators need to implement innovative curricula and educational methods to prepare for and adapt to the disruptive changes that lie ahead.

40. Ohtsuki H, Kawakami M, Kawakami T, Takahashi K, Kirita T, Komasa Y. Risk of osteoporosis in elderly individuals attending a dental clinic. International Dental Journal 2017 Apr;67(2):117-122. OBJECTIVE: Osteoporosis has become a critical public health problem with the rapidly aging population in Japan. It is necessary for dentists to know their patients' status because it influences dental treatment. The purpose of this study was to predict the risk of osteoporosis in elderly patients visiting a dental clinic by assessing mandibular cortical morphology on panoramic radiographs. METHOD: Three-hundred and thirty patients were divided into three classes based on the morphology of their mandibular cortex on panoramic radiographs. Mandibular cortical bone width at the mental foramen was also measured. Bone mineral density (BMD) was determined at the calcaneus using a quantitative ultrasound device. RESULTS: The mandibular cortical width decreased significantly from Class 1 (normal cortex), to Class 2 (moderately eroded cortex) and to Class 3 (severely eroded cortex). BMD was negatively correlated with age in both female and male patients. Most (108/186) female patients had a class 3 cortex with a low BMD. Among women, mandibular cortical width was significantly correlated with BMD. Thirty-three percent of the female had received a previous diagnosis of osteoporosis. In contrast, only 13.9% (20/144) of the male had a Class 3 cortex. In men, mandibular cortical width did not significantly correlate with BMD. Only a few of the men had received a previous diagnosis of osteoporosis. The number of remaining teeth did not correlate with low BMD in either sex. CONCLUSION: Our findings reveal that most elderly female patients visiting the dental clinic had a high risk of osteoporosis and a low BMD.

41. Totu EE, Nechifor AC, Nechifor G, Aboul-Enein HY, Cristache CM. Poly(methyl methacrylate) with TiO2 nanoparticles inclusion for stereolitographic complete denture manufacturing - the fututre in dental care for elderly edentulous patients? Journal of Dentistry 2017 Apr;59:68-77. OBJECTIVES: The aim of this study was to obtain a Poly(methylmethacrylate) (PMMA)-TiO2 nanocomposite material with improved antibacterial characteristics, suitable for manufacturing 3D printed dental prosthesis. METHODS: 0.2, 0.4, 0.6, 1, 2.5 by weight% of TiO2 nanoparticles have been added to the commercially available stereolithographic PMMA material and the obtained nanocomposites have been analyzed using FTIR, SEM and also tested for antimicrobial efficacy against bacterial cultures from Candida species (C. scotti). RESULTS: SEM images and EDX results highlighted the presence of TiO2 in PMMA nanocomposites. The elemental composition (EDX) also

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showed the presence of other fillers included in stereolithographic PMMA solution. FTIR analysis clearly revealed changes in polymeric matrix structure when adding TiO2 nanoparticles. Sample containing 0.4, 1 and 2.5wt% TiO2 nanoparticles inhibited the growth of Candida scotti strain in standard conditions according to the toxicity control method (DHA). Increasing quantity of nano-titania has resulted in particles fooling, forming new aggregates instead of the homogenous dispersion of nanoparticles with modified viscosity characteristics and expected lower mechanical parameters. CONCLUSIONS: Significant improvements in polymer characteristics and nice dispersion of the TiO2 nanoparticles have been noticed for 0.4wt%, therefore it was used for stereolitographic complete denture prototyping. CLINICAL SIGNIFICANCE: Incorporation of TiO2 nanoparticles in PMMA polymer matrix was proved to have antibacterial effects, specifically on Candida species. The newly obtained 0.4% nanocomposite was successfully used with stereolitographic technique for complete denture manufacturing. However, mechanical and biocompatibility tests need to be performed in order to extend the clinical usage. Copyright © 2017 Elsevier Ltd. All rights reserved.

42. Mukherjee A, Livinski AA, Millum J, et al. Informed consent in dental care and research for the older adult population: A systematic review. Journal of the American Dental Association 2017 Apr;148(4):211-220. BACKGROUND: Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. METHODS: The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research. RESULTS: The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research. CONCLUSIONS: Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research. PRACTICAL IMPLICATIONS: This review is the first attempt, to the authors' knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients. Copyright Published by Elsevier Inc.

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