Medications as risk factors for periodontal disease

Behavioral Patterns of Depression Patients and Control Population

Behavioral and multifactorial factors, such as psychological, nutritional, dental pathology, and physical activity habits, are factors that control depression. The objective of the present study was to analyze the differences in the behavioral, psychological, nutritional, dental pathology, and physical activity patterns of the depressed and control population. Forty-eight participants with depression (45.7 ± 12.0) and one hundred participants in a control group without any pathology or medication (48.9 ± 7.9) were interviewed using an online questionnaire. The multifactorial items of psychology, oral behavior, nutritional habits, and physical activity profile were analyzed through a set of questionnaires. The results showed how the depression group showed significantly higher psychological measures related to personality, anxiety, depression, loneliness, perceived stress, and psychological inflexibility than the control group. The control group showed significantly higher weekly vitality, vitality at the end of the week, weekly frequency of juice, wine, coffee, fresh vegetable salad, and Bristol scale than the depression group. Higher values of migraine headache, weekly soft drink frequency, and digestion after meals were found in the depression group. In addition, patients with depression also presented poor dental health, presenting higher rates of gastritis or heartburn, dry mouth, dental sensitivity, and sick days per year than the control group. Both groups presented a pattern of low physical activity. This information allows a better understanding of a multifactorial disease, as well as the creation of intervention and prevention protocols for this disease at a behavioral and lifestyle level.

The outcome of a preventive dental care programme on the prevalence of localized aggressive periodontitis in Down's syndrome individuals

BACKGROUND

Periodontal disease in Down's syndrome (DS) individuals develops earlier and is more rapid and extensive than in age-matched normal individuals. The present study evaluated a group of DS patients, who had been participating in a 10-year preventive dental programme, for the impact of the programme on their periodontal status.

METHODS

Thirty DS patients (mean age 23.3 +/- 4 years) were compared with 28 age-matched healthy controls (mean age 22.8 +/- 5 years). The hygiene level, gingival condition and periodontal status (periodontal probing depth, clinical attachment level and radiographic alveolar bone loss) were determined.

RESULTS

In spite of similar oral hygiene and gingival measures, DS patients, as opposed to the control ones, had a severe periodontal disease. The prevalence, extent and severity of periodontitis in the DS group were significantly greater than in the control group. The teeth most commonly and severely affected were the lower central incisors and the upper first molars. DS patients lost significantly more teeth due to periodontitis.

CONCLUSIONS

The clinical and radiographic picture found in the present DS group is characteristic of localized aggressive periodontitis. Within the limitations of this study, it seems that the preventive dental programme had no effect on periodontal destruction progression of localized aggressive periodontitis in DS individuals and that impaired oral hygiene plays a relatively minor role in the pathogenesis of this disease. Future controlled studies are needed to assess the effectiveness of different preventive dental programmes in preventing the progression of periodontitis in DS patients.

Xerostomic medications and oral health: the Veterans Dental Study (part I)

OBJECTIVES

To quantify the adverse effects of the number of xerostomic medications on dental caries, oral mucosa, and periodontal disease.

DESIGN

Secondary analysis of a cross-sectional study of the Veterans Dental Study.

SETTING

Four New England area VA outpatient clinics.

SUBJECTS

The sample consists of 345 male veterans participating in The Veteran's Dental Study who also had pharmacy records.

MAIN OUTCOME MEASURES

Oral health data included total surfaces of coronal caries, a modification of the root caries index, mean oral mucosa scores, and Community Periodontal Index of Treatment Need (CPITN). Oral health parameters were measured and recorded in clinical dental examinations.

EXPOSURES

Intake of xerostomic medications 14-385 days prior to the dental examination.

STATISTICAL ANALYSES

The relationships between exposure and outcome were analyzed via linear and logistic regression methods adjusting for possible confounding factors such as disease burden index, alcohol consumption, dental care, and smoking status.

RESULTS

Veterans who were taking at least one xerostomic medication were almost three times more likely to have mean mucosa scores in the worst 25 percentile than veterans taking no xerostomic medications, OR = 2.63 (confidence interval [CI] 1.34, 5.16, p = 0.03) after adjusting for age, number of teeth, disease burden index, income, smoking and alcohol use. Participants who were taking at least one xerostomic medication experienced higher but non-significant increases in coronal (OR = 1.21; CI. 0.66, 2.25) and root caries (OR = 1.10 CI. 0.54, 2.24) measured by numbers of total decayed surfaces.

CONCLUSION

There were significant deleterious effects of xerostomic medications on oral mucosa. However, xerostomic medications do not appear to increase coronal caries, or periodontal index measured by CPITN among ambulatory, community dwelling participants who were able to perform routine preventive oral care.

Oral health care among nursing home residents in Avon

OBJECTIVE

To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention.

DESIGN

Descriptive survey, interview and clinical data.

SETTING

22 randomly selected nursing homes in the Bristol area.

METHOD

412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries.

RESULTS

Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects.

CONCLUSIONS

Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.