Biomedical subjects

M I MacEntee

Publications and source records attributed to M I MacEntee.

At least 19 recordsLinked to original sources

PubMed2003

Assessment of periodontal conditions and systemic disease in older subjects.

BACKGROUND: An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). AIMS: 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. MATERIAL AND METHODS: Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60-75 years old (mean age 67.6, SD+/-4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) > or =5 mm, clinical attachment levels (CAL) > or =4 mm were studied in a subset of 701 of the subjects. RESULTS: IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD > or =5 mm and the proportion of PD with > or =5 mm was significantly smaller in the non-diabetic group (chi2=46.8, p<0.01, and chi2=171.1, p<0.001, respectively). Statistical analysis failed to demonstrate group differences for the number and proportions of sites with CAL > or =4 mm and for radiographic findings of alveolar bone loss. Combining all periodontal parameters revealed that the Mantel-Haenszel common odds of having IDDM/NIDDM and periodontitis was 1.8 : 1 (95% CI: 1.1-3.1, p<0.03). The common odds ratio estimate of an association between heart disease and diabetes was 3.6 : 1 (95% CI: 2.1-2.6, p<0.001). CONCLUSIONS: Probing depth differences between IDDM/NIDDM vs. non-diabetic subjects may reflect the presences of pseudo-pockets and not progressive periodontitis in many subjects with diabetes mellitus. Periodontitis is not a predominant coexisting disease in older subjects with diabetes mellitus.

Age Factors↗

PubMed2002

Assessment of periodontal conditions and systemic disease in older subjects. I. Focus on osteoporosis.

BACKGROUND: Osteoporosis (OPOR) is a common chronic disease, especially in older women. Patients are often unaware of the condition until they experience bone fractures. Studies have suggested that OPOR and periodontitis are associated diseases and exaggerated by cytokine activity. Panoramic radiography (PMX) allows studies of mandibular cortical index (MCI), which is potentially diagnostic for OPOR. AIMS: i). To study the prevalence of self-reported history of OPOR in an older, ethnically diverse population, ii). to assess the agreement between PMX/MCI findings and self-reported OPOR, and iii). to assess the likelihood of having both a self-reported history of OPOR and a diagnosis of periodontitis. MATERIALS AND METHODS: PMX and medical history were obtained from 1084 subjects aged 60-75 (mean age 67.6, SD +/- 4.7). Of the films, 90.3% were useful for analysis. PMXs were studied using MCI. The PMXs were used to grade subjects as not having periodontitis or with one of three grades of periodontitis severity. RESULTS: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2% self-reported OPOR. The intraclass correlation between MCI and self-reported OPOR was 0.20 (P < 0.01). The likelihood of an association between OPOR and MCI was 2.6 (95%CI: 1.6, 4.1, P < 0.001). Subjects with self-reported OPOR and a positive MCI had worse periodontal conditions (P < 0.01). The Mantel-Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P < 0.001). CONCLUSIONS: The prevalence of positive MCI was high and consistent with epidemiological studies, but only partly consistent with a self-reported history of osteoporosis with a higher prevalence of positive MCI in Chinese women. Horizontal alveolar bone loss is associated with both positive self-reported OPOR and MCI.

Aged↗

PubMed2000

Oral care for successful aging in long-term care.

The oral health of frail elders residing in long-term care facilities is very poor, probably because access to dental services is limited and help with daily mouth care is almost nonexistent. Recent concerns and interest have been raised through the cooperation of administrators, nursing staff, and dental personnel to address this apparent neglect. Moreover, evidence shows that caries and periodontal disorders can be managed successfully in geriatric populations. Consequently, there is a basis on which to develop a practical strategy for mouth care that should reduce the morbidity and early mortality in long-term care and to assist an increasingly frail and dependent population to age successfully.

Aged↗

PubMed1999

An index of clinical oral disorder in elders (CODE).

Attempts to construct an index of oral health or disorder suitable for older adults have been limited in clinical scope or based on the judgement of very few individuals. Consequently, we present here a multidimensional index of Clinical Oral Disorder in Elders (CODE) based on a breadth of clinical measures relevant to elders. The data for the index are derived from a clinical examination of jaw function, dentures, mucosa, teeth, and periodontium. Weighting or ranking for each disorder within the context of an elderly person was established as mild, moderate or severe by experienced dental clinicians and dental hygienists. Subsequently, the index was constructed by transforming the weights into a numerical value for each clinical measure. Individual scores can relate to the heaviest weight identified during the examination or to the sum of the weights assigned throughout the examination, and the average score during a series of examinations will reflect the clinical status of a particular population. Clinical applications in elderly residential-care populations indicate that the index can be constructed efficiently and with reasonable reliability. We suggest, therefore, that the CODE index is suitable for descriptive and comparative research by providing a clinical format for measuring oral disorder in disabled elders, and, when combined with a psychosocial index, it should be very comprehensive indicator of oral dysfunction in older adults.

Aged↗

PubMed1998

Prosthodontic profiles relating to economic status, social network, and social support in an elderly population living independently in Canada.

STATEMENT OF PROBLEM: Previous evaluations of life satisfaction and health have not completely explained the impact of social network, social support, and economics on the oral health-related behavior of elderly patients, particularly in relation to missing teeth. PURPOSE: This study measured the strength of associations between social network/support/class and the use of complete and removable partial dentures in elderly patients living independently. MATERIAL AND METHODS: A multiple stepwise logistic regression was used to contrast data from previous studies relating to the subject and to explore the influence of these social variables. RESULTS: The results substantiated the links observed in a previous study between some social features and oral fitness. More frequent use of complete dentures was identified among participants who reported higher incomes and among those who thought their incomes were sufficient for their needs. Unreplaced missing anterior teeth were associated more commonly with subjects less willing or able to leave their homes. CONCLUSIONS: Some salient features of prosthodontic care and oral health status were common to 2, comparable social environments. A minority within the elderly population may not see a need to make use of clinical dental services, regardless of how accessible these services are to them. Social network and social support issues may be important determinants in this perceived need to use clinical services.

Activities of Daily Living↗

PubMed1998

The economics of complete dentures and implant-related services: a framework for analysis and preliminary outcomes.

It is not always clear that the implant-prosthesis offers distinct advantages over the conventional complete denture for managing the edentulous jaw. This article discusses the measurement, distribution, impact, and management of the edentulous jaw, and describes a framework for analyzing the economic costs and benefits associated with the conventional denture and the implant prosthesis. There are physiologic and psychosocial costs and benefits to both the conventional denture and the implant prosthesis, which indicates that neither method is distinctly superior. The physiologic costs are low and the psychosocial costs are similar for both treatments, whereas the direct financial costs associated with the implant prosthesis are substantially higher.

Bone Resorption↗

PubMed1998

Age, gender, dentures and oral mucosal disorders.

The numbers of participants over 75 years of age in previous studies of oral health have not been sufficient to permit a full investigation of the influence of age on the mouth. In this study a disproportionate stratified random sample of 255 independent elders was selected from a list of urban voters to provide similar numbers of men and women in three age groups. The subjects were interviewed and examined, and nearly half of them had mucosal disorders. There was a significant (P < 0.05) association between mucosal lesions and the use of dentures and tobacco, whereas stomatitis, denture-related hyperplasia and angular cheilitis in particular were associated significantly with men and with the use of defective dentures. Logistic regression revealed that neither age alone nor the quality of dentures predispose to mucosal lesions, but that the odds of finding stomatitis, denture-related hyperplasia and angular cheilitis in particular increased about three-fold in denture-users, and almost doubled in men.

Age Factors↗

PubMed1997

The significance of the mouth in old age.

Information on the significance of the mouth in old age has been obtained from structured interviews with older subjects focused largely on the significance and impact of oral dysfunction. There is, however, a growing sense that inventories of dysfunction do not explain the full significance of aging and that structured interviews offer little opportunity to explore feelings and concerns. This study adopted a qualitative approach to collect and analyse data from unrestricted responses to the question: "What is the significance of oral health in the lives of older adults?" The data were collected by interviewing 24 elders, and major themes in transcripts of the interviews were identified by the research team using inductive analytical techniques. Our findings indicate that the significance of oral health in this age group was considered largely within the context of three interacting themes--comfort, hygiene and health--that can be illustrated within a theoretical framework that corresponds with more general theories of aging to offer guidance for health promotion and further research. Overall, the participants offered a positive perspective on the mouth, and they emphasized the need to adapt as an integral part of successful aging and a means of coping with the impact of oral disorders.

Aged↗

PubMed1996

Novel fracture toughness test using a notchless triangular prism (NTP) specimen.

The aim of this study was to develop and validate a new method for determining the fracture toughness of materials and adhesive interfaces. The new test specimen is a notchless triangular prism (NTP) which, when placed in the testing holder, achieves a configuration similar to that of the standard chevron-notched short rod (CNSR) specimen. It can be cast, ground, or simply machined easily and reproducibly without cutting an initial notch. Finite element analysis of a modeled NTP specimen loaded in tension showed a stress distribution similar to a CNSR specimen. A very good correlation was obtained between the NTP and CNSR fracture toughness values of poly(methyl methacrylate) during a calibration study. Fracture toughness values similar to those reported in the literature were obtained for several dental materials and one adhesive interface using the NTP test. The fracture patterns were indicative of plane strain conditions during testing. All bulk specimens and most of the adhesive specimens showed crack arrest, which suggested a stable, well-controlled testing procedure. These results suggest that the NTP fracture toughness test can be used to determine the fracture mechanics of bulk materials and adhesive interfaces.

Biocompatible Materials↗

PubMed1996

Short-term contamination of luting cements by water and saliva.

OBJECTIVES: The aim of this study was to determine the effect of water, artificial saliva and natural saliva on the hardening process of three dental luting cements. METHODS: Cement samples, 1 mm thick and 5 mm in diameter, were subjected to various storage conditions in an oven maintained at 37 degrees C. Some samples were aged in 100% humidity or water for up to 1 wk. The other samples were covered with water, artificial saliva or natural saliva at various times after mixing. The Knoop hardness values of the cement surfaces were measured. Differences between groups were evaluated with an ANOVA followed by a Tukey multiple comparison at the 5% level of significance. The hardness ratio of the contaminated samples was calculated using the 30 min mean KHN of the samples aged in 100% humidity as the divisor. RESULTS: The glass ionomer samples were significantly harder (48.3 +/- 3.8) than the zinc phosphate (38.9 +/- 7.5) or composite cements (35.4 +/- 10.2) after 1 wk in 100% humidity storage condition. When immersed in water, the hardness of both the glass ionomer and the zinc phosphate decreased to almost half that of the specimens stored in 100% humidity (26.2 +/- 2.7 and 16.9 +/- 2.5, respectively). Contamination decreased the hardness of zinc phosphate and glass ionomer (hardness ratio, water contamination at 5 min: 0.39 +/- 0.10 and 0.52 +/- 0.12, respectively) but had very little effect on the composite. Overall, water had a greater softening effect than artificial or natural saliva on the cements. SIGNIFICANCE: In light of these results, glass ionomer cement should be protected from water and saliva for the first 15 min after mixing.

Analysis of Variance↗

PubMed1996

Measuring the impact of oral health in old age: a qualitative reaction to some quantitative views.

Investigations into the oral health-related beliefs and behaviour of old people are complex and fraught with methodological difficulties. They have employed to a large extent structured interviews or questionnaires based on the Sickness Impact Profile to explain the impact of oral disorder in old age. However, despite sophisticated statistical techniques, the results have failed to explain much of the variance in the responses of the elderly subjects. This paper reviews the results of several investigations conducted in a structured and quantitative manner, and contrasts them with an alternative method of inductive investigation using a more qualitative interpretation of open-ended interviews. The alternative method of exploration with a small but intensely involved group of elderly participants revealed a view of oral health that reflects a willingness of elders to adapt constructively to changes in the mouth with advancing age. Moreover, the construction of a framework of oral health-related beliefs and behaviours that emerged from the qualitative analysis of open-ended interviews, has widened our understanding of the significance of the mouth in old age beyond the framework of biophysical, functional and disabling variables that dominated previous research on this field.

Aged↗

PubMed1994

Denturists and oral health in the aged.

The activities of denturists have been the source of annoyance and alarm to dentists. The dental profession has been unsuccessful in curtailing the prosthodontic service provided by denturists directly to the public despite frequent warnings about the risk to oral health. In many countries denturists have become a legitimate part of the health service in competition with dentists. This article explains the historic circumstances leading to the widespread acceptance of denturists in Canada in contrast to the rejection of these services in Great Britain. It demonstrates that dentists generally were not opposed to an alternative complete denture service and that there is little evidence of a serious threat to the oral health from the complete dentures made by denturists.

Aged↗

PubMed1994

Clinical epidemiologic concerns and the geriatric prosthodontic patient.

Investigations of the oral health of the elderly leave little doubt that disease and dysfunction are plentiful, although there is some debate on how the clinical observations translate into treatment needs. The problems appear to be greatest among the disabled and the institutionalized, whereas dentists generally show little enthusiasm for offering their services outside the confines of the traditional dental practice. Consequently the oral health concerns in the older population, and especially as they relate to prosthodontic treatment, remain substantially unanswered.

Aged↗

PubMed1994

How severe is the threat of caries to old teeth?

Caries is a bacterial infection caused by a complex interaction of biologic and behavioral factors. It is believed that caries is a major threat to teeth in old age, yet little information is available on the incidence and progress of carious lesions in elderly teeth. All too often caries is diagnosed after a visual and tactile examination of tooth structure without thought for the other factors essential to the initiation and support of an active lesion. Prospective studies have been conducted recently in Vancouver to quantify associations between the incidence of caries and many of the behavioral, bacteriologic, and physiologic factors potentially influencing oral health in old age. The results indicate that improvements in hygiene may hold the most promise for controlling this infection in an elderly population.

Aged↗

PubMed1994

Problems with prostheses on implants: a retrospective study.

Prosthetic parameters for implant success have not been well defined but should include patient satisfaction and prosthesis maintenance, including adjustments and repairs. In addition, differences between fixed and removable implant-supported prostheses (ISPs) should be quantified. This study retrospectively evaluated both patient satisfaction and maintenance for 156 patients. Removable ISPs averaged almost three times as many adjustments per prosthesis (2.1 versus 0.8 per fixed ISP) and more than twice as many repairs (1.9 per removable ISP versus 0.9 per fixed ISP). The most common adjustments were to the contour of both types of prosthesis, and the most frequent repairs involved the retentive clips with removable ISPs and the gold screws with fixed ISPs. The incidence of repeat repairs was more than twice as high with removable prostheses compared with fixed prostheses. However, the repairs to opposing dentures most often needed were for conventional dentures opposing fixed ISPs. The vast majority of repairs were needed within the first year of service. Despite the high maintenance needed, patients were satisfied with both types of ISP, with the exception of limited satisfaction with cleansability, particularly with fixed restorations. The high incidence of early repairs, and the greater potential for a removable ISP requiring adjustment and repair, should be considered both when discussing options with the patient and when estimating treatment and maintenance costs before the commencement of implant therapy.

Adult↗

PubMed1994

Estimates of time and propensity for dental treatment among institutionalised elders.

The oral health and concerns of elderly residents were surveyed in a stratified random selection of 41 long-term care facilities in Vancouver. The residents who could participate were examined and interviewed to determine their oral health and concerns about dental treatment. The need and time required for treatment were estimated in six groups to reflect the propensity for treatment in dentate and edentate subjects. The propensity for treatment was high in about one-third of the participants whereas it was unlikely that one-tenth of those examined would ever use a dental service. In general, there was a widespread need for a diagnostic service because so few had been examined by a dentist in the previous year. Prosthodontics accounted for most of the treatment in all of the propensity groups, with substantially more time required by the dentate residents. There was also a substantial need for management of mucosal pathoses and oral hygiene and, to a lesser extent, for dental restorations and endodontics. Overall, our estimates indicate a substantial need for dental treatment among residents of long-term care facilities, although the need is reduced by half if the propensity for treatment is considered.

Aged↗

PubMed1994

Restorative treatment for geriatric root caries.

The restorative management of root caries poses many challenges to the clinician. The clinical features of root caries and current restorative techniques using new adhesive materials are discussed.

Aged↗

PubMed1994

The roots of dentistry in ancient China.

The history of dentistry in China is closely aligned with the remarkable developments in Chinese medicine over at least six millennia. Rudimentary dental extractions were performed as early as 6000 BC, when the first signs of adornment with human teeth were described. There were actually four distinct periods of medical development in China: the Mystical Period; the Golden Period; the Controversial Period; and the Transitional Period. The Golden Period was marked by the appearance of the first textbooks to describe preventive and restorative dental techniques, as well as the first colleges. Dentistry then moved through the dark times of the Controversial Period, when war mongering stymied progress. Lasting until 1800 AD, it came to an end with the domination of Western medicine and dentistry. This paper chronicles the development of dentistry in China, revealing that it has been a part of Chinese life for a long time.

China↗