Dental management of patients with Alzheimer's disease and other dementias.
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Biomedical subjects
R L Ettinger
Publications and source records attributed to R L Ettinger.
Reflections on changes in geriatric dentistry.
The development of geriatric dental education programs in the United States and at the University of Iowa over the last twenty years is reviewed. The program at Iowa evolved from a didactic elective program taught by a single faculty person to required didactic and clinical programs that include a special care clinic in the dental school and a mobile unit with portable equipment serving ten area nursing homes with comprehensive care. Factors influencing the curriculum development are identified and discussed, and as no dental schools are the same, some general applications are suggested from the Iowa experience.
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Patient management and decision making in complete denture fabrication using a duplicate denture procedure: a clinical report.
A patient may have difficulty adapting to a new prosthesis for either physical or psychological reasons. This article describes a procedure for duplicating an existing denture and gives the practitioner an alternative to the traditional denture fabrication techniques. The duplicated denture fabrication technique minimizes the changes to the new denture, making it easier for the patient to adapt to new dentures. However, in-depth communication with the patient is necessary for successful denture therapy.
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Epidemiology of dental caries. A broad review.
There is evidence from many sources that dental caries is an ancient disease; it has been found all over the world in skulls from the time humans replaced hunting with agriculture as the main source of food for survival. This article examines the epidemiology of dental caries with a specific focus on the twentieth century and high-risk groups.
Adult↗
The future of dental care for the elderly population.
The U.S. population is aging, and the elderly are maintaining many of their natural teeth. Studies have shown that if older people have teeth, they tend to utilize dental services to a similar extent as younger cohorts. Geriatric dental care is the diagnosis, treatment, and prevention of dental and oral diseases for all older adults. A functional categorization of the aging population is more useful in dentistry than a chronological one, and 70 percent of this population, or 23.2 million people, is able to visit a dentist in his or her office. The oral health care of older adults has become more challenging because they will no longer accept extraction and dentures as a solution to complex restorative needs. This paper discusses these issues and looks at the future of geriatric dental care.
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In vitro evaluation of topical fluorides for overdenture abutments.
STATEMENT OF PROBLEM: Topical fluorides are effective, yet none have been developed specifically for root or dentin surfaces. PURPOSE: This study evaluated the ability of several commercial topical fluorides to protect overdenture abutments from in vitro acid demineralization. MATERIAL AND METHODS: Twenty extracted teeth from persons aged 50 to 70 years were prepared for overdenture abutments. The teeth were sectioned to provide 40 buccal and lingual halves, covered with nail varnish except for windows on the occlusal and root surfaces, and randomly divided into 4 groups of 10 specimens, which were cycled for 6 hours in acid demineralization, washed, and then held 17 hours in a remineralizing solution for 18 days. Before each cycle, the specimens were treated with either Karigel, Karigel-N, or a NaF solution. The control group was treated with fluoride-free solution. RESULTS: The depth of the artificial lesions on the root surfaces showed a statistically significant dose response. On the occlusal, there were no differences in lesion depth between the various topical fluorides and the control group. But there was a dose response when the remineralized band was subtracted from the lesion depth. Remineralization bands in the occlusal lesions were not evident in the control group, but were present in the fluoride groups. CONCLUSION: This study suggests that higher concentrations of NaF are more protective for overdenture abutments.
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Denture duplication technique with alternative materials.
This denture duplication technique uses addition silicone impression material. It is an easy, time-efficient method that allows the fabrication of the duplicate denture at a convenient time.
Dental Impression Materials↗
A comparison of patient satisfaction and dentist evaluation of overdenture therapy.
It has been argued that the retention of some teeth in the jaws as overdenture abutments prevents negative feelings about the loss of natural teeth. This study set out to evaluate how satisfied a group of patients were with wearing overdentures, and to compare their subjective evaluations with those of a dentist using objective criteria to examine the prostheses. A questionnaire was developed using questions adapted from several other studies. It was pretested, modified and used on all patients who were members of a longitudinal study of overdentures that started in 1974, and who returned on recall. At the end of 9 months, 101 subjects had completed the questionnaire and examination. The mean age of the patients was 65.9 years with an age range of 35 to 88 years. There were 68 men and 33 women in this study and 62 of them were satisfied with their dentures; 33 were satisfied, but felt they had some faults. Only 6 were unhappy about wearing the overdentures. The average length of time the dentures had been worn was 6.9 years, with a range of 1 to 15 years. The most frequent complaints were loss of retention (65.4%) and discomfort (62.2%) of the mandibular dentures. A number of correlations were evaluated and some significant relationships were found between dentist and patient evaluation of the dentures. The best predictor of patient satisfaction with denture wearing was the patient's perception of retention and appearance. In the maxilla the patient's ability to chew and the dentist's evaluation of occlusion were also significant predictors. In the mandible the only other factors apart from retention and appearance were patient comfort and age.
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The unique oral health needs of an aging population.
Over the last century, the number and percentage of older adults has increased dramatically. In the last 30 years, the percentage of older edentulous adults has declined significantly but the total number is expected to remain constant at 9 million until the year 2020. The increasing number of and percentage of dentate adults will have more teeth at risk for caries and periodontal disease. Many of these adults will have multiple medical problems and be taking various pharmacotherapies which will complicate oral disease and its treatment. New concepts in prevention of oral disease will be required, as will more accurate diagnostic procedures, especially to identify the at-risk older adults.
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Review: xerostomia: a symptom which acts like a disease.
This review considers the changes in salivary glands associated with ageing and concludes that there is no evidence to show that xerostomia is likely to result from the ageing process alone. The four main factors causing xerostomia are presented and it can be seen that the condition is a side-effect of diseases and the drugs used to treat these diseases. As xerostomia has a significant effect on a person's quality of life, a multifaceted approach to treating xerostomia is presented. All health care workers should be sensitive to those complaining of dry mouth and help them to seek care.
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The old-old dental patient: the challenge of clinical decision-making.
As the U.S. geriatric population grows older, dentists should recognize the need to carefully consider age-related concerns that influence clinical decision-making. The authors discuss several prevalent problems typically found in "old-old" patients and propose a model for determining the appropriate extent of dental care for them.
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Evaluating the longevity of restorative materials that seal the root canals of overdenture abutments.
Researchers have not established which restorative materials are most appropriate to seal the root canals of overdenture abutments. The author evaluated the longevity of a spherical amalgam, a composite resin and a glass ionomer in 123 patients. Results of this study showed a significant difference between the glass ionomer and the other two materials with regard to the time from placement to replacement of the restorations.
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Factors influencing the future need for treatment of root surfaces.
This paper discusses the current status of root surface caries in the elderly population and the need for treatment of this condition in the future. Although root surface exposure and root caries have been reported for adults at all ages, the people at greatest risk for these conditions are the elderly. In the United States, life expectancy and the population aged 65 years and older has increased substantially, and the proportion of the elderly population who are dentate has increased and is projected to increase further. Utilization of dental services by the elderly is similar to that of employed adults. Interpretation of studies of the prevalence and incidence of root surface caries are difficult due to differences in sampling, definition of lesions, and reporting conventions. Root surface caries prevalence is related to age and continues to be a significant problem for this population as they age. Factors that may affect the future need for treatment are explored.
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Effect of fluoride on overdenture abutments.
This study evaluated the caries preventive effects of high concentrations of fluoride on overdenture abutment teeth. Twenty-four extracted caries-free teeth were randomly selected from a pool of patients aged 50-70 and prepared as for overdenture abutments. The teeth were sectioned mesiodistally into two halves. All surfaces on the teeth were painted with a protective varnish except for a window on the root surface and one on the cut dentin of the occlusal. The 48 root halves were randomly divided into four groups of 12 specimens. Each group received a different 4-minute treatment prior to being placed in a demineralizing solution for 6 hours. The treatment groups were (1) distilled H2O only; (2) 1,000 ppm F-; (3) 5,000 ppm F-; and (4) 10,000 ppm F-. The teeth were cycled for 6 hours in the demineralizing solution and 17 hours in a fluoride-free remineralizing solution for 17 days. Sections were cut at 100 +/- 10 microns through the windows. Standardized photomicrographs were made under polarized light using distilled H2O and quinoline as the imbibing media. Microradiographs were made of the same specimens and these were also photographed at the same magnification. The depths of the lesions were measured from drawings of the lesions projected on a digitizer screen. The amount of demineralization was calculated by subtracting the width of the mineralizing bands from the depth of the lesion. The conclusions were: (1) Lesions on the root surface were much shallower than on the occlusal; (2) A dose response to the fluoride concentration of the topical application was evident.
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Demography and dental needs, an international perspective.
The population of the world is changing and the science dealing with the study of these changes in human populations, in terms of disease, health and mortality has been called demography. It can be understood to include the evaluation of the size, density, and distribution of populations including the influence of a variety of factors such as age and economics. This paper will review the distribution of the world's population with regard to age and utilization of dental care with particular emphasis on the older cohorts.
Adolescent↗
Managing and treating the atrophic mandible.
Changes in age and disease patterns suggest that in the near future complete denture wearers will be older and have worn dentures for a longer time, but will also be more physically fragile. Some diagnostic issues related to support problems for mandibular complete dentures are evaluated and treatment modes suggested.
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Measurement of the interface between bone and immediate endosseous implants: a pilot study in dogs.
This study developed methodology to evaluate the healing of 15 IMZ implants placed in the sockets of freshly extracted mandibular premolars in three adult mongrel dogs. Six surgical sites were prepared in each animal and one site was left as a control. Porous hydroxyapatite was placed around the top half of two implants in each animal; one implant was also covered with polytetrafluoroethylene membrane. All implants were covered with a mucoperiosteal flap and sutured closed. Upon animal sacrifice, the mandibles were retrieved for block dissection and the blocks were embedded in plastic. Serial longitudinal wafers were ground to 50 to 100 microns and stained. Standard photomicrographs were taken so that tracings of the implant-bone interface could be measured on a sonic digitizer. The mean percent amount of bone to plasma-sprayed portion of the implant on the longitudinal sections was 47.9% +/- 5.2% with a range of 17.4% to 84.7%. The horizontal sections were measured at 53.5% +/- 3.7% with a range of 0.0% to 100%. This pilot study suggests that IMZ implants placed in fresh extraction sockets can achieve a degree of intimate contact with bone; however, wide variation in the implant-to-bone interface was found even in the same specimen.
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Management of elderly patients in the private practice system.
The distribution of the world's population has resulted in a significant increase in both the number and percentage of older adults in the industrially developed countries. The ageing populations in these countries are tending to maintain natural teeth longer and so require preventive and restorative dental services as they age. The majority of these populations live in the community and are functionally independent while a much smaller minority have become frail. An even smaller minority are institutionalised, hospitalised or home-bound. The majority of those who live in the community can utilise the services of dentists working in their own private offices or government clinics provided dentists are sensitive to their needs.
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