Epidemiological study on improving the QOL and oral conditions of the aged--Part 1: The relationship between the status of tooth preservation and QOL

Lack of Association between Interleukin-1β Gene Polymorphism (rs16944) and Chronic Periodontitis: From a Case-Control Studies to an Updated Meta-Analysis

Background

Interleukin-1β (IL-1β) plays an important role as a mediator of various inflammatory responses in chronic periodontitis. Several studies have investigated the potential relationship between IL-1β polymorphism (rs16944) and susceptibility to chronic periodontitis; inflammatory process is involved, but conclusions is still controversial.

Objective

The aim of this study was to determine whether the IL-1β polymorphism (rs16944) is associated with susceptibility to chronic periodontitis.

Material and Methods

For the case-control study, 51 patients with chronic periodontitis and 33 healthy control patients were recruited in the study. Genotyping was conducted by direct sequencing. SNPStats and SPSS 18.0 were used for the analysis of genetic data and to evaluate odds ratios, 95% confidence intervals, and P values; logistic regression models were used. And to perform meta-analysis, studies about IL-1β polymorphism (rs16944) and chronic periodontitis were searched in PubMed, Embase, Google Scholar, and Korean Studies Information Service System (KISS) electronic databases until July 2017.

Results

In our case-control study, no significant relationship was revealed between IL-1β polymorphism (rs16944) and chronic periodontitis (P > 0.05 in each model). When combined with the previous studies in the meta-analysis, the result was not associated with chronic periodontitis in any of the models (CC vs. CT + TT: OR = 0.97, 95% CI = 0.762–1.246; CC + CT vs. TT: OR = 0.90, 95% CI = 0.658–1.232; and C vs. T: OR = 0.93, 95% CI = 0.774–1.128). The subgroup analysis stratified by ethnicity showed a weak association between the IL-1β polymorphism (rs16944) and chronic periodontitis in the Caucasian population (recessive model, OR = 1.34, 95% CI = 1.017–1.758, P = 0.037).

Conclusion

Evidences from a case-control study and the meta-analysis suggest that IL-1β polymorphism (rs16944) is not associated with susceptibility to chronic periodontitis.

Edentulism and quality of life among older Ghanaian adults

Background

Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults.

Methods

Secondary analysis of WHO’s Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Participants included a nationally representative sample of adult’s aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question “How would you rate your overall quality of life?”. To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman’s correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate.

Results

Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure.

Conclusion

Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it.

Dificuldades diárias associadas às próteses totais

A efetividade de serviços de saúde pode ser avaliada pela ótica da qualidade de vida. Assim, este estudo avaliou o serviço de reabilitação a partir das dificuldades diárias associadas a próteses totais convencionais (PTC), produzidas entre 2007 e 2009, pelos Centros de Especialidades Odontológicas (CEO) de uma mesorregião do Rio Grande do Norte (RN). Realizou-se um estudo seccional com 138 usuários dessas PTC, coletando-se os dados por exame clínico e questionário baseado no indicador Oral Impacts on Daily Performances. Utilizaram-se os testes de Fisher e Qui-quadrado para testar associação das variáveis. Como resultado, 42% da amostra relatou dificuldades, relacionadas à PTC, para executar atividades bucais. Tais dificuldades foram mais frequentes e intensas nas atividades de comer, falar e sorrir. No total, 58,7% da amostra não tinha dentes funcionais. Quanto à avaliação clínica das PTC, 57,2% das superiores e 9,2% das inferiores estavam satisfatórias. Houve associação da presença de dificuldades e a ausência de dentes funcionais, mas não com PTC inadequadas. Assim, os CEO foram efetivos na reabilitação com PTC superior, já que as dificuldades encontradas integram limitações próprias a tal reabilitação. Por outro lado, o custo benefício da reabilitação inferior deve ser reavaliado.

Relationship of smoking and smoking cessation with oral health status in Japanese men

BACKGROUND AND OBJECTIVE

Smoking has been associated with the number of natural teeth a person has and with the likelihood of periodontitis. The purpose of this study was to determine the relationships between the number of teeth present and periodontal diseases with smoking habits in a cohort of Japanese men.

MATERIAL AND METHODS

The study group comprised 1088 men, 40-75 years of age. Oral examinations were conducted in dental clinics. Information on smoking status and on oral health behavior was collected from self-administered questionnaires. The relationship between oral health status and smoking status was estimated using adjusted odds ratios.

RESULTS

Compared with those whom had never smoked, the odds ratios of having more than eight missing teeth and having periodontitis, among current smokers, were 1.67 and 1.74, respectively. In those who had stopped smoking for 11 years or longer, there was no increase in the odds ratio of having more than eight missing teeth and periodontitis, compared with those whom had never smoked.

CONCLUSION

Smoking has a positive association with missing teeth and periodontitis. However, smoking cessation is beneficial for oral health. The odds of having more than eight missing teeth, or of having periodontitis, in those who had never smoked was similar to that of individuals who reported that they had stopped smoking for 11 years or more.

Recognition and behaviour of caregiver managers related to oral care in the community

OBJECTIVES

The purposes of this study were to investigate the knowledge, practice and educational background of caregiver managers regarding oral health, how they cope with visiting activities, and to explore related factors to develop an appropriate working strategy for them in the community.

METHODS

The subjects were 102 caregiver managers, who voluntarily participated in a seminar organised by the M city government. The collected data were analysed to assess the relationship between the related factors of oral health, career and age, and the correlation amongst items of action process concerning oral health using Spearman's correlation coefficient and Fisher' s exact test with spss 14.0 for Windows.

RESULTS

The results were as follows; (i) the mean length of careers of home-care staff and caregiver managers was 3.6 +/- 3.2 and 1.6 +/- 1.6 years respectively, (ii) 90.2% recognised the importance of oral care and 92.2% were interested in oral care, although 32.4% hesitated to provide oral care, (iii) the career of caregiver managers was not significantly related to recognition of concrete objectives of oral care, soft debris and symptoms of periodontal disease, but they recognised the effectiveness of oral care in prevention of aspiration pneumonia, (iv) there was a total of 11 significantly correlated items of knowledge, recognition and practice of oral care and (v) there was a total of 10 significantly correlated items amongst factors of action process.

CONCLUSION

Results suggested that knowledge of oral care was related not only to the career but also to age and revealed a basic gap in the range of abilities between the respondent caregiver managers. Some did perform appropriate oral care and carried out the necessary processes.

Edentulism and comorbid factors

INTRODUCTION

Complete edentulism is the terminal outcome of a multifactorial process involving biological factors and patient-related factors. It continues to represent a tremendous global health care burden, and will for the foreseeable future. The purpose of this review is to determine what comorbid factors exist for the completely edentulous patient.

METHODS

This literature review evaluated articles obtained via the National Library of Medicine's PubMed Website, using keywords of edentulism with various combinations of the terms comorbidity, incidence, health, nutrition, cancer, cardiovascular health, diabetes, osteoporosis, smoking, asthma, dementia, and rheumatoid arthritis. Abstracts were selected and screened, and selected full-text articles were reviewed. Articles were limited to those with adequate patient cohorts and a minimum of 2-year follow-up data.

RESULTS

Edentulism was found to be a global issue, with estimates for an increasing demand for complete denture prostheses in the future. Completely edentulous patients were found to be at higher risk for poor nutrition, coronary artery plaque formation (odds ratio 2.32), to be smokers (odds ratio 2.42), to be asthmatic and edentulous in the maxillary arch (odds ratio 10.52), to being diabetic (odds ratio 1.82), to having rheumatoid arthritis (odds ratio 2.27), and to having certain cancers (odds ratios varying from 1.54 to 2.85, depending on the type of cancer). Chronic residual ridge resorption continues to be the primary intraoral complication of edentulation, and there appear to be few opportunities to reduce bone loss in the edentulous patient.

CONCLUSIONS

While the completely edentulous patient seems to be at risk for multiple systemic disorders, whether development of these disorders is causal or casual has not been determined. To minimize the loss of residual alveolar ridges, exemplary complete denture therapy, along with the establishment of routine recall systems, should be the ultimate goal of treatment of this patient cohort.

Increased frequencies of caries, periodontal disease and tooth loss in patients with Parkinson's disease

We aimed to evaluate oral hygiene in patients with Parkinson's disease (PD). The incidence of periodontal disease and numbers of caries and remaining teeth were checked in 89 consecutive 60 to 79-year-old patients with PD and compared with two other patient groups: 68 patients with mild neurological disease, and 60 with acute ischemic stroke. Patients with PD had fewer remaining teeth, more caries and a higher incidence of deep periodontal pockets. The frequency of patients with PD with untreated caries was high at Hoehn and Yahr stage II and above, and frequency tended to increase in patients who had low compared to high mini-mental state examination scores. Careful attention should be paid to the oral hygiene of patients with PD, even in the early stages of the disease.

Analysis of gene expression profiles in human periodontal ligament cells under hypoxia: the protective effect of CC chemokine ligand 2 to oxygen shortage

Periodontal ligament (PDL) cells appear to play important functional roles in response to mechanical stress. We hypothesized that hypoxia caused by a deformation of blood vessels and the following ischaemia may play a crucial role in differential gene expression in PDL cells affected by mechanical stress. Gene induction in cultured human PDL cells by hypoxia was analyzed using cDNA array, followed by RT-PCR analysis. Eleven hypoxia-responsive genes were found differentially expressed under low-oxygen conditions in PDL cells. Among them, CCR2, CC chemokine ligand 2 (CCL2) receptor was studied in more detail since little information is available on the role of chemokines in adaptive responses of PDL cells under hypoxia. Here we investigate whether CCR2 mediates the signalling to maintain the homeostasis of PDL cells. We found that cell death of PDL cells was induced under hypoxia with down-regulation of CCL2 mRNA expression. However, the exogenous CCL2 prevented PDL cell death under oxygen shortage with the increment of cellular inhibitor of apoptosis (cIAP) mRNA expression. The present study demonstrated substantial effects of hypoxia on gene expression of CCL2 and CCR2 in PDL cells, indicating that mechanical loading accompanied with mild hypoxia allows PDL cells to elicit adaptive responses with up-regulation of CCR2.

Oral status and its association with general quality of life in older independent-living south-Brazilians

BACKGROUND

There are few studies assessing the importance of oral status, particularly tooth loss, edentulism and satisfaction with mastication, on the perception of quality of life (qol) in general. The objective of this study was to evaluate if oral status was associated with lower ratings in the WHO Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) domains.

METHODS

In this cross-sectional study, a random sample of 872 Southern-Brazilians aged 60 years or more was evaluated using a structured questionnaire to assess sociodemographic data, qol (WHOQOL-BREF), and depressive symptoms (Geriatric Depression Scale). Oral examinations assessing the number of teeth and saliva flow were performed. Additionally, participants were asked to rate their satisfaction with the ability to chew. Correlates of poorer qol (i.e. values of the WHOQOL-BREF < or = median) were assessed by means of multivariate logistic regressions.

RESULTS

Poorer qol in the physical domain was associated with increasing age, income, living in rural areas, >2 chronic conditions, intake of medications, depressive symptoms, edentulism, and reporting difficulty for chewing food. Poorer qol in the psychological domain was associated with income, schooling, >2 chronic conditions, intake of medications, depressive symptoms, and difficulty for chewing. Poorer qol in the environment domain was associated with income, living in urban areas, depressive symptoms, and difficulty for chewing. Poorer qol in the social relations domain was associated with living in urban areas, depressive symptoms, and difficulty for chewing.

CONCLUSION

In the studied population, oral status was associated with the perception of quality of life in general.

Relationship between number of natural teeth in older Japanese people and health related functioning

The objective was to assess the relationship between number of functional occluding natural pairs of teeth and health related functioning in older free living Japanese people using the SF-20. The participants were 107 elderly people aged 80 years. Health related functioning was measured with the SF-20. The numbers of functional occluding natural pairs of teeth (OPs) were calculated and scored as follows: 1, for each pair of anterior teeth and premolars in occlusion. Molar functional natural occluding pairs were scored 2 for each occluding pair. The number of functional occluding pairs was assessed separately as anterior natural occluding pairs (AOPs) and posterior occluding pairs (POPs). There were significant differences in the role functioning subscale of SF-20 between those who were edentulous and those with one to nine natural teeth and 10 or more natural teeth (P = 0.030). Those with one to six AOPs had significantly higher role functioning than the zero AOPs group (P = 0.042). Those with 1-12 POPs also had significantly higher role functioning scores than the zero natural POPs group (P = 0.007). However, there were no significant relationships between number of natural teeth, OPs or AOPs, and POPs on the one hand, and all other subscales of SF-20 on the other hand. The community-dwelling 80-year-old Japanese people in this study had overall good health related functioning. The number of functional occluding pairs of natural teeth, especially POPs, was related with the role functioning subscale of SF-20 but had no significant relationships to the other dimensions of SF-20.

What has ageing to do with periodontal health and disease?

Periodontitis is a multi-factorial disease and in most cases also a disease with a chronic progression. Exposure to factors which contribute to periodontitis occurs over a long period, so that at the time of diagnosis it may be difficult to identify and evaluate what co-factors have contributed to its development. These include exposure to bacteria and viruses, inflammation, genetic factors, health behaviours and a variety of social factors, socio-economic status, behavioural and nutritional habits, the ability to cope with stress and the ability of the immune system to fight infections. Many patients in their 50s also experience other conditions such as heart disease, diabetes mellitus, or rheumatoid arthritis and recent reports on the associations and potential biological mechanisms by which periodontitis can be linked to other systemic diseases suggest that the patient with periodontitis is a challenged individual. Neither individuals nor their oral health care providers are currently prepared for the challenges in oral health care as the expectation of successful ageing with remaining and aesthetically functional teeth is increasing. The scientific evidence is, however, growing, and while the opportunities to prepare for successful ageing exist they must be included in the educational process of both current and future oral health care providers and their patients.

Chewing ability and quality of life in an 80-year-old population

As quality of life (QOL) could be influenced by oral status in the elderly, we examined whether chewing ability or number of teeth affected QOL in 80-year olds. A cross-sectional survey included dental examination, chewing self-assessment, and a QOL questionnaire. A total of 823 people who were 80 years old participated in this study. QOL was assessed in terms of satisfaction with physical condition, meals, daily living and social interactions, and with face-scale scores. After adjustment for gender, spouse and activities of daily living, dissatisfaction with social interactions was 3.9 times more prevalent in individuals able to chew four foods or fewer than in those chewing 15. Dissatisfaction with physical condition, meals and daily living, and poor face-scale scores, were 2.7, 2.4, 3.4, and 2.4 times more prevalent, respectively, in subjects chewing four foods or fewer. The number of teeth showed little effect. In conclusion, self-assessed chewing ability but not number of teeth was associated with QOL in 80-year-old subjects.

Life-style Correlates of Tooth Loss in an Adult Midwestern Population

OBJECTIVES

To describe life-style correlates of tooth loss in a representative rural American population.

METHODS

Information on tooth loss as well as past medical history and life-style factors was obtained in a well-defined cohort of 2,764 persons 53-96 years of age in Beaver Dam, WI (1998-2000).

RESULTS

There were 1,992 (68.2%) persons missing some and 447 (15.3%) missing all of their teeth. In univariable analyses, age, cigarette smoking, heavy drinking, education, multivitamin use, and diabetes status were associated with tooth loss. Tooth loss was associated with poorer self-rated health and with difficulty eating solid food and inability to enjoy some food. In multivariable models age, education, smoking, heavy drinking, and diabetes were significantly associated with tooth loss.

CONCLUSIONS

Tooth loss is common in older persons and is associated with many risk factors including education, smoking, and heavy drinking. It is possible that modifying these may influence risk of tooth loss.