Aging and Oral Health: Effects in Hard and Soft Tissues

Oral health of chemotherapy patients before and after provision of oral hygiene instructions at a tertiary care hospital: pre-post design

OBJECTIVE

Disturbances in the oral mucosa is a major concern among patients undergoing chemotherapy. One of the most significant barriers in the implementation of oral care is the lack of knowledge. The aim of the study was to assess gingival and periodontal health status of chemotherapy patients before and after the provision of oral hygiene instructions.

METHODS

A single group, pre-post test was conducted to assess oral health status of patients at the daycare chemotherapy, Aga Khan University Hospital, Karachi, Pakistan. Oral hygiene instructions were given with study models and leaflets. Patients were followed for 6-weeks. Oral health was assessed by using Simplified-Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Differences in indices were analyzed in STATA version-15.0 using Generalized Estimating Equation (GEE) and Wilcoxon Signed-rank test.

RESULTS

Out of 74, 53 (72%) patients completed study follow-up. Improvement in the OHI-S was found in 14 (26%) patients (p-value < 0.001). GEE showed that age [adjusted OR = 1.10; 95% CI: 1.03-1.11], current chemotherapy cycle [adjusted OR = 1.19; 95% CI: 0.98-1.46], highest education level [Adjusted OR = 1.37; 95% CI: 1.08-12.7] and cancer therapy [Adjusted OR = 0.12; 95% CI: 0.24-0.55] were significantly associated with the change in OHI-S. Wilcoxon signed-rank test showed positive changes in the CPI (p-value < 0.001).

CONCLUSIONS

Basic oral hygiene instructional intervention can be effective in improving the oral hygiene of chemotherapy patients. Nurses should also play a key role in providing psychological and nutritional support to patients.

Correlation between different points on the face and the width of maxillary anterior teeth

Statement of problem

There is currently no consensus on the relationship between maxillary anterior teeth and different facial anthropometric measurements. Additionally, whether these relationships vary by age and sex remains unreported.

Purpose

This clinical study aimed to investigate the relationship between the intercanine distance (ICaD) and intercanthal distance (ICD), interpupillary distance (IPD), interalar width (IAW), and intercommissural width (ICW), and to compare whether these relationships differ between different age and sex populations.

Material and methods

Participants (n = 409) were enrolled according to the inclusion criteria, and their standardized digital images were taken to measure facial and oral segments through an image processing program. The differences between ICaD and four facial measurements and the sexual differences for all measurements were compared using the 1-sample t-test. The differences among different age groups for all measurements were compared using the one-way analysis of variance (ANOVA) test, and a least significant difference (LSD) test was used for multiple comparisons. The association between ICaD and the four facial measurements was evaluated using Pearson correlation analysis. The correlation between ICaD and four facial measurements was evaluated using linear regression. Differences in regression equations among the subgroups were evaluated through subgroup regression analysis and the significance test of the difference between the two regression coefficients. Tests of significance were two-sided, with alpha level of 0.05. The reliability of the results was evaluated by calculating intraclass correlation coefficients.

Results

The ICD, IPD, ICW, and IAW significantly differed from the ICaD in both sexes (P < 0.01). All measurements were significantly greater in men than in women (P < 0.01). The differences among the age groups were statistically significant for all measurements except IPD (P < 0.05). A significant positive correlation was found between all facial measurements (r = 0.258 [ICD], r = 0.334 [IPD], r = 0.389 [ICW], and r = 0.393 [IAW]) and the ICaD in both sexes. The highest correlation was found between ICW(r = 0.345) and ICAD in men and IAW (r = 0.285) and ICAD in women. Except for the 20-29 and 50-59 age groups, the mathematical equations of ICaD and facial anthropometric measurements differed among the other age groups and sexes.

Conclusions

ICD, IPD, ICW, and IAW cannot be directly used to determine ICaD in both sexes. Nevertheless, when observed from the frontal aspect, by the use of digital images, all facial measurements correlated to the intercanine distance, with a high probability. The mathematical formulae combined with facial anthropological measurements can help ensure the combined width of the six maxillary anterior teeth, but the effects of sex and age differences should be considered.

Viscoelastic behavior of oral mucosa. A rheological study using small-amplitude oscillatory shear tests

The purpose of this work was to determine the viscoelastic behavior of porcine and human oral mucosa under physiological conditions of temperature, hydration and chewing. The linear elastic and viscous shear moduli of these soft tissues were determined by small-amplitude oscillatory shear (SAOS) tests at masticatory frequency using a stress-controlled rheometer equipped with an immersion cell on punched biopsies 8 mm in diameter. Non physiological conditions of temperature were also used to access other parameters such as the denaturation temperature of collagen. First, the different parameters such as normal force, frequency and maximal strain were adjusted to obtain reliable data on porcine mucosa. The optimal normal force was 0.1N and the linear viscoelastic limit was found for a strain amplitude of 0.5% for both 0.1 and 1 Hz. The storage moduli of porcine mucosa, ranging from 5 to 16 kPa, were in the same range as cutaneous tissues determined by SAOS at equivalent frequencies. The storage modulus, superior to the loss modulus G″, indicates a predominant elastic contribution to shear stress in chewing conditions. Second, this protocol evidenced an influence of the anatomic site of the mouth on the viscoelastic behavior of porcine mucosa, mandibular biopsies having higher storage moduli than maxillary biopsies. Temperature scans showed the mechanical manifestation of collagen denaturation in the 60-70 °C range as previous calorimetric analyses. Finally, this mechanical protocol was successfully adapted to characterize human mucosa in an elderly population. It was shown that the elastic modulus is impacted by local inflammation (gingivitis), decreasing significantly from 6 ± 1.4 kPa to 2.5 ± 0.3 kPa.

Oral microbiome variations related to ageing: possible implications beyond oral health

The global population is getting older due to a combination of longer life expectancy and declining birth rates. Growing evidence suggests that the oral microbiota composition and distribution may have a profound effect on how well we age. The purpose of this study was to investigate age-related oral microbiome variations of supragingival plaque and buccal mucosa samples in the general population in Latvia. Our results indicated significant difference between supragingival plaque bacterial profiles of three age groups (20-40; 40-60; 60 + years). Within supragingival plaque samples, age group 20-40 showed the highest bacterial diversity with a decline during the 40-60 age period and uprise again after the age of 60. Among other differences, the important oral commensal Neisseria had declined after the age of 40. Additionally, prevalence of two well-documented opportunistic pathogens Streptococcus anginosus and Gemella sanguinis gradually rose with age within our samples. Furthermore, supragingival plaque and buccal mucosa samples significantly differed in overall bacterial composition.

Reconstruction of Natural Smile and Splinting with Natural Tooth Pontic Fiber-Reinforced Composite Bridge

Teeth replacement is challenging in old patients with severe periodontal disease, limiting prosthetics treatment options. Here, we report a fiber-reinforced composite (FRC) resin bridge using natural tooth pontic in a patient with severe periodontitis. A 60-year-old lady complaining of teeth mobility was diagnosed with severe periodontitis, recession, bone loss, and crowding in the anterior maxillary teeth. Due to a hopeless periodontal prognosis, lateral incisors were extracted and sectioned using a cylindrical diamond bur. The pulp chamber was debrided and filled with self-adhesive flowable composite resin. After three weeks, the pontics were fixed in proximal contact areas, and the FRC bridge was fabricated directly using the resin fiber strip followed by occlusion adjustment, finishing, and polishing. Esthetic, occlusion, and periodontal status were re-evaluated after six months. Here, FRC using natural pontic could successfully reconstruct a natural smile, splint the adjacent teeth, eliminate crowding, and provide stable occlusion. Therefore, this method may be considered for similar cases.

Diagnostic Aspects of an Included Third Molar in an 88-Year-Old Patient: A Case Report and Literature Review

Included third molars in elderly patients are quite rare in dental practice, and therefore easily misdiagnosed, because these teeth are usually extracted in youth. Additional challenges to correctly diagnosing such a dental condition, and its associated complications, arise from frequent co-morbidities in elderly patients, and from difficult communication with the patient. We report a case of an 88-year-old female patient, who presented in the dental emergency room complaining of a discomfort caused by the sharp edges of her lower incisors, and requesting their extraction; the final diagnosis, of suppurated pericoronitis at tooth 48, was concluded based on the clinical elements and X-ray examination.

Проценка на оралното здравје кај геријатриски пациенти

Геријатриската популација во  Македонија претставува специфична група која има потреба од континуирана евалуација на нивното орално здравје. Според податоците на СЗО во 2010 година, 12 % од населението во Македонија било на возраст 65+ години. Стареењето е процес со различни специфични промени во сите системи и органи, вклучувајќи го и орофацијалниот систем. Најчестите состојби поврзани со возраста кај геријатриската популација се губење на забите, пародонтопатија, преканцерозни лезии и орални карциноми, ксеростомија, ресорпција на резидуалниот алвеоларен гребен и целокупна дисфункција на орофацијалниот систем. Големо е влијанието на извршената протетичка терапија кај геријатриските пациенти врз нивното целокупно и општо здравје. Целта на оваа студија беше да се процени состојбата на меките ткива кај геријатриските пациенти, особено кај пациентите со протетички третмани, нивното орално здравје и влијанието на оралното здравје врз квалитетот на животот. Материјал и методи: Спроведовме опсервациона студија на пресек кај геријатриските пациенти, а геријатрискиот индекс за проценка на оралното здравје (GOHAI) беше употребен за да се изврши евалуација  на нивното орално здравје и влијанието на оралните состојби и извршениот дентален третман врз квалитетот на животот. Резултати: Испитаниците со просечна возраст од 72,88 години пријавиле повеќе општи и системски заболувања, а главните фактори на ризик за промените на оралната мукоза биле пушењето и пиењето алкохол. Вкупна анодонција е забележана кај 37,5% од испитаниците и делумна анодонција кај 62,5%. Просечниот период на носење протези изнесуваше 7,8 години. Вкупната оценка за квалитетот на животот и оралното здравје на испитаниците варираше во интервалот 1,93 ± 0,65, а просечната вредност кај субјектите со протетички конструкции за p> 0,05 (p = 0,19) беше нешто повисока во однос на субјектите без било каква протетичка изработка. Заклучок: Резултатот на GOHAI-12 во студијата имаше ниска вредност, помалку од 50 што покажа дека испитаниците беа со слабо орално здравје. Според резултатите од самооценувањето, имаше слаба до умерена перцепција за нивното оралното здравје. Потребен е интегриран пристап за да се постигне критично позитивно ниво на општото и оралното здравје кај геријатриските пациенти.

Phyto-fabricated Nanoparticles and Their Anti-biofilm Activity: Progress and Current Status

Biofilm is the self-synthesized, mucus-like extracellular polymeric matrix that acts as a key virulence factor in various pathogenic microorganisms, thereby posing a serious threat to human health. It has been estimated that around 80% of hospital-acquired infections are associated with biofilms which are found to be present on both biotic and abiotic surfaces. Antibiotics, the current mainstream treatment strategy for biofilms are often found to be futile in the eradication of these complex structures, and to date, there is no effective therapeutic strategy established against biofilm infections. In this regard, nanotechnology can provide a potential platform for the alleviation of this problem owing to its unique size-dependent properties. Accordingly, various novel strategies are being developed for the synthesis of different types of nanoparticles. Bio-nanotechnology is a division of nanotechnology which is gaining significant attention due to its ability to synthesize nanoparticles of various compositions and sizes using biotic sources. It utilizes the rich biodiversity of various biological components which are biocompatible for the synthesis of nanoparticles. Additionally, the biogenic nanoparticles are eco-friendly, cost-effective, and relatively less toxic when compared to chemically or physically synthesized alternatives. Biogenic synthesis of nanoparticles is a bottom-top methodology in which the nanoparticles are formed due to the presence of biological components (plant extract and microbial enzymes) which act as stabilizing and reducing agents. These biosynthesized nanoparticles exhibit anti-biofilm activity via various mechanisms such as ROS production, inhibiting quorum sensing, inhibiting EPS production, etc. This review will provide an insight into the application of various biogenic sources for nanoparticle synthesis. Furthermore, we have highlighted the potential of phytosynthesized nanoparticles as a promising antibiofilm agent as well as elucidated their antibacterial and antibiofilm mechanism.

Psychometric properties of the Urdu version of the Geriatric Oral Health Assessment Index (GOHAI) and oral health-related quality of life in the elder Pakistani population

OBJECTIVE

The study aimed to translate the English version of the Geriatric Oral Health Assessment Index, assess its reliability and validity, and demonstrate its psychometric properties with regard to OHRQoL in the elder Pakistani population.

MATERIAL AND METHODS

In this cross-sectional study, 408 elder people were randomly recruited from three day-care centres. In the translation process, the translated Urdu version was reviewed by a committee of experts, followed by back-translation into English and re-reviewed by the same committee of experts. The questionnaire sought information about socio-demographic characteristics information and self-perception of oral, general health and treatment needs. OHRQoL was examined using GOHAI-U, and intraoral examination recorded the decayed, missing, and filled teeth. Reliability, internal consistency, convergent and discriminant validity of GOHAI-U were examined.

RESULTS

The mean GOHAI-U score was 40.2 (SD = 5.7, range = 20-55). The Cronbach's alpha for GOHAI score was 0.71, item-scale correlation coefficients ranged from 0.63 to 0.76, and test-retest correlation ranged from 0.59 to 0.74. Three factors supported the theoretical construction in the component factor analysis of the index. For convergent validity, there was a significant relationship between the GOHAI score and self-perceived oral, general health and treatment needs (P < .05). For discriminant validity, a significant correlation was found between the GOHAI score and clinical measures of dental health status except with the carious teeth.

CONCLUSION

The GOHAI-U has sufficient reliability and constructs validity to be used as an efficient measure of oral health-related quality of life in the Pakistani elder population.

Susceptibility of Dental Enamel of Different Ages to Caries-Like Lesion Development

This study investigated the impact of estimated age, anatomical location, and the presence of wear facets on the susceptibility of enamel to develop caries-like lesions. Extracted human premolars (n = 261) had their age estimated between 10 and 93 years old, using established forensic methods. Specimens of enamel (4 × 4 mm) were prepared from the middle of the buccal surfaces, preserving the outer surface layer. The central area of the block (4 × 1 mm) was protected with nail polish and used as an internal control. The specimens were demineralized for 8 days (with 0.1 M acetic acid, 1.28 mM Ca, 0.74 mM Pi, and 0.03 µg F/mL, pH 5.0), to simulate caries-like lesion development. They were then scanned individually using microtomography, and digital 2D images were used to calculate the outcomes of integrated mineral concentration loss (ΔZ in µm/g/cm3) and lesion depth (LD in µm) at 3 locations, i.e., the cervical, middle, and occlusal thirds. The presence of natural surface wear facets was considered in the analysis. Data were evaluated using a linear mixed-effects models (α = 0.05). ΔZ increased significantly as a function of estimated tooth age at all 3 locations, and this increase was greater after the age of 30 years (p < 0.001), when a higher ΔZ was found in the occlusal third than in the middle and cervical thirds (p < 0.001). LD increased only in the occlusal third before the age of 30 years (p = 0.039) and this increase was significantly greater after 30 years at all 3 locations (p < 0.01), with no differences among them (p > 0.15). The presence of wear facets significantly increased ΔZ and LD (p < 0.001 for both). Overall, we concluded that the susceptibility of enamel to developing caries-like lesions increased with estimated dental age. This effect was more pronounced after the estimated age of 30 years and in the presence of natural tooth wear facets.

Early detection of oral cancer and potentially malignant disorders: Experiences, practices, and beliefs of prosthodontists practicing in Saudi Arabia

STATEMENT OF PROBLEM

Data on the oral cancer screening skills and beliefs of prosthodontists practicing in Saudi Arabia are lacking.

PURPOSE

The purpose of this survey was to assess the beliefs, experiences, and practices of prosthodontists practicing in Saudi Arabia regarding the early detection of oral cancer and potentially malignant disorders.

MATERIAL AND METHODS

A cross-sectional, questionnaire-based survey was conducted on prosthodontists practicing in Saudi Arabia. A 26-item questionnaire was sent to all eligible prosthodontists (N=250). The collected data were analyzed with a statistical software program.

RESULTS

The response rate was 57.2% (N=143). The majority of participants (79%) reported that they routinely examined all new patients for mucosal pathologies. However, only 58% reported that they examine their patients at recall visits, and only 61.5% stated that they provide tobacco use or smoking cessation advice. With regard to the respondents' experiences with suspicious mucosal lesions, the majority said that they had detected a suspicious lesion (79.7%) and had referred affected patients (83.2%) during their career. Most prosthodontists (65%) believed that they were able to detect oral cancer on their own, and 40% believed that they could influence their patients to stop smoking. A lack of training, confidence, time, and financial incentives were reported as barriers to oral cancer screening.

CONCLUSIONS

Most of the prosthodontists surveyed in this study appeared motivated to perform routine oral mucosal screening. However, more efforts are needed to help improve the attitudes, confidence, and skills of prosthodontists when it comes to identifying and referring suspicious oral mucosal lesions.

Cellular ageing of oral fibroblasts differentially modulates extracellular matrix organization

BACKGROUND AND OBJECTIVES

Ageing is associated with an impaired cellular function that can affect tissue architecture and wound healing in gingival and periodontal tissues. However, the impact of oral fibroblast ageing on the structural organization of the extracellular matrix (ECM) proteins is poorly understood. Hence, in this study, we investigated the impact of cellular ageing of oral fibroblasts on the production and structural organization of collagen and other ECM proteins.

METHODS

Oral fibroblasts were serially subcultured, and replicative cellular senescence was assessed using population doubling time, Ki67 counts and expression of P21^WAFI . The production and structural organization of ECM proteins were assessed at early (young-oFB) and late (aged-oFB) passages. The thickness and pattern of collagen produced by live cultures of young- and aged-oFB were assessed using a label-free and non-invasive second harmonic generation (SHG)-based multiphoton imaging. Expression of other ECM proteins (fibronectin, fibrillin, collagen-IV and laminins) was evaluated using immunocytochemistry and confocal microscopy-based depth profile analysis.

RESULTS

Aged-oFB displayed a higher population doubling time, lower Ki67+ cells and higher expression of P21^WAFI indicative of slower proliferation rate and senescence phenotype. SHG imaging demonstrated that young-oFB produced a thick, interwoven network of collagen fibres, while the aged-oFB produced thin and linearly organized collagen fibres. Similarly, analysis of immunostained cultures showed that young-oFB produced a rich, interwoven mesh of fibronectin, fibrillin and collagen-IV fibres. In contrast, the aged-oFB produced linearly organized fibronectin, fibrillin and collagen-IV fibres. Lastly, there was no observable difference in production and organization of laminins among the young- and aged-oFB.

CONCLUSION

Our results suggest that oral fibroblast ageing impairs ECM production and more importantly the organization of ECM fibres, which could potentially impair wound healing in the elderly.

Incidental findings detected on cone beam computed tomography in an older population for pre-implant assessment

OBJECTIVES

The aim of this retrospective study was to record incidental findings in CBCT scans taken in an older population for pre-implant assessment, and to examine whether these findings would influence the intended dental implant placement.

METHODS

300 consecutive CBCT scans over the age of 40 years was carried out. The incidental findings were grouped into regions as follows: dentoalveolar structures, maxilla and mandible, paranasal sinuses, temporomandibular joint (TMJ), naso/oral-pharyngeal airway, cervical spine and neurovascular canals. The incidental findings are further categories into their significance towards the intended treatment plan.

RESULT

Incidental findings were noted on all of the scans. 555 incidental findings (1.85 findings/scan) were identified. The highest number of incidental findings was in the sinuses (34%), followed by dentoalveolar structures (31%), nasal/oral-pharyngeal airway (12%), maxilla and mandible (10%), TMJ (6%), cervical spine (4%) and neurovascular canals (3%). A total of 37% of findings required follow-up. In 12% of cases detection of the incidental findings lead to amendment or abortion of the intended implant treatment plan.

CONCLUSION

Incidental findings within and beyond the region of interest are common in CBCT scans. The numbers of incidental findings per scan in an older population is higher than in a younger population.

Role of dental pulp in age estimation: A quantitative and morphometric study

Context:

This study was designed to characterize the role of the dental pulp (DP) in age estimation.

Aim:

The analysis of age-related quantifiable changes in DP components such as odontoblasts, collagen fibers, and blood vessels.

Subjects and Methods:

One hundred and twenty extracted teeth from six age groups (20–30 years, 31–40 years, 41–50 years, 51–60 years, 61–70 years, and 71–80 years) were subjected to decalcification and routine histopathological processing followed by Hematoxylin and Eosin and Picrosirius Red staining. Evaluation of the number of odontoblasts, mean vessel area (MVA), mean vessel diameter (MVD), and collagen fiber thickness were done.

Statistical Analysis Used:

ANOVA test, Fisher's test, and Regression Analysis.

Results:

Reduction in the number of odontoblasts/mm of pulp-dentinal border, MVA, and MVD were seen with advancing age. Rise in collagen fiber thickness was noted with increasing age. All parameters showed strongly statistically significant differences between age groups with P < 0.001 (ANOVA test).

Conclusions:

Regression formulae derived for age estimation based on data collected demonstrated linear correlation with age. Collagen fiber thickness had the highest accuracy followed by odontoblast numbers and MVA. MVD was the least accurate among the factors considered. However, the highest accuracy of 90.9% was seen when all parameters were incorporated together in a single equation.

Construction of a comprehensive observer-based scale assessing aging-related health and functioning in captive rhesus macaques

Aging-related health and functioning are difficult to quantify in humans and nonhuman primates. We constructed an observer-based scale for daily application in assessing the aging-related health and functioning of rhesus macaques. Ten items referring to an aging appearance, musculoskeletal aging and aging-related eating behavior were selected through a panel consensus. The Aging-related Health and Functioning Scale (AHFS) was constructed based on these scored items form 57 healthy rhesus macaques. High reliability of the AHFS was shown based on Cronbach’s alpha coefficient (0.877). The structure of the AHFS was validated by three exploratory factors. The largest factor, whose four components were dietary uptake, iliac muscle mass, hair condition and fragility, and sex, explained 50.5% of the variation in aging-related health and functioning scores. The second factor, involving age, tooth loss and tooth wear, explained 15.5% of the variation. The lowest-ranking factor comprised only facial redness and accounted for 10% of the variation. A hierarchical cluster analysis validated the good applicability of the scale in distinct samples. From these scale-scored results, complicated aging phenomena observed in humans, including the sex-survival paradox and the calorie-related health-survival paradox, were both demonstrated in rhesus macaques. Therefore, the AHFS provides a valuable approach for aging-related research.

A model for comprehensive oral biological age score with oral and systemic clinical parameters

BACKGROUND

Biological age reflects the functional status of an individual. The purpose of the study was to develop a model for estimating oral biological age with oral and systemic parameters.

METHODS

A total of 248 subjects who had a routine health check were assessed with oral and general clinical examination. Chi-square test was performed to screen oral clinical candidate indicators. General parameters were analyzed by Pearson correlation coefficient and principal component analysis to develop a general biological age score. A final comprehensive model of oral biological age score was established by combining oral and general biological age score.

RESULTS

A total of eight oral indicators (mucosal blood blister, mucosal dryness, impacted tooth, missing teeth, residual crowns, dental calculus, gingival hyperemia, and gingival recession) and 10 general clinical indicators (triglyceride, creatinine, blood urea nitrogen, glucose, total cholesterol, mean erythrocyte hemoglobin concentration, mean erythrocyte hemoglobin, uric acid, body weight, and systolic blood pressure) were selected for oral and general biological age score, respectively (r > 0.25, P < 0.05). A model of comprehensive oral biological age score was then formed by principal component analysis: 0.046 triglyceride + 0.010 creatinine + 0.141 blood urea nitrogen + 0.048 glucose + 0.068 total cholesterol + 0.014 mean erythrocyte hemoglobin concentration + 0.082 mean erythrocyte hemoglobin + 0.001 uric acid + 0.020 body weight + 0.005 systolic blood pressure + 0.037 oral biological age score -10.908. The score was increased accordingly with CA.

CONCLUSION

Oral biological age can be easily estimated clinically by the model of comprehensive oral biological age score using oral and systemic clinical parameters by general practitioners.

3-dimensional analysis about the effects of aging and risk factors on changes in oral environment

PURPOSE

The purpose of this study is to investigate the effects of aging and various risk factors on the oral environment and to analyze them in 3-dimensions.

MATERIALS AND METHODS

A total of 800 patients were enrolled in this study, and subjects were divided into 4 groups by age-under 55, 56 - 65, 66 - 75, and over 76. Based on their most recent visit, the number of crowns, bridges, implants, and the remaining natural teeth were recorded. Smoking habits, along with presence of diabetes and hypertension, were surveyed, as risk factors were also set as a variable. Comparisons among the groups or within the groups were performed by independent t-test, and one-way and two-way ANOVA. Kruskal-Wallis test and Mann-Whitney U test were used for analysis. It was assumed to be statistically significant when P value is below .05.

RESULTS

Changes in the number of crowns, bridges, implants, and the remaining natural teeth by age were statistically significant. When we examined the effect of risk factors on the change of variables with age, hypertension was found to affect the number of bridges. Diabetes and smoking were found to affect the number of the remaining natural teeth. The other variables were not statistically significant.

CONCLUSION

Aging is considered to be an important variable affecting the change of oral environment. Among the risk factors, the presence of smoking habit and diabetes is thought to have a great influence on the change of the number of the remaining natural teeth.

Teeth and Covariates: Association with Risk of Falls

Purpose

Falls occur commonly in geriatric populations and undesirably influence their life, morbidity, and mortality. The aim of this study was to analyze the association between the number of teeth present among the elderly population and covariates in relation to the risk of falls.

Materials and Methods

This study was conducted at various old age homes in the Klang Valley region of Malaysia involving the geriatric population aged 60 years and above. A detailed questionnaire consisting of sociodemographic data including sex, age, household income, and dental variables such as the number of teeth and chewing difficulty was obtained. The Tinetti test (TT) was used to evaluate the patients' ability to walk, to maintain postural balance, and to determine their risk of falling. The short version of the Geriatric Depression Scale was used to assess depression among the participants, and the Barthel Scale was used to analyze the subject's ability to perform the activities of daily living (ADL).

Results

Statistically significant association was observed in relation to the number of teeth present and risk of falls (p < 0.05). Subjects who had 19 teeth or less in total had moderate to highest risk of falls (p=0.001) in comparison with subjects who had 20 teeth or more. Those aged 70 years and above showed the highest risk of falls (p=0.001) in comparison with the subjects aged between 60 and 69 years. Subjects with depression (p=0.03) and presence of illness related to fall showed statistically significant difference (p=0.001) in comparison with those who did not suffer from the same. Compromised ADL (p=0.001) (which included ability to perform several tasks like indoor mobility, climbing stairs, toilet use, and feeding) and low monthly income (p=0.03) was also observed among subjects who had higher risk of falls.

Conclusion

According to the results achieved, there was a high statistically significant association observed between the number of teeth present, age, depression, ADL, and presence of illness in relation to the risk of falling among the geriatric population. Henceforth, oral rehabilitation of elderly patients with less number of teeth may reduce their risk of falls.

Oral health in geroscience: animal models and the aging oral cavity

Age is the single greatest risk factor for many diseases, including oral diseases. Despite this, a majority of preclinical oral health research has not adequately considered the importance of aging in research aimed at the mechanistic understanding of oral disease. Here, we have attempted to provide insights from animal studies in the geroscience field and apply them in the context of oral health research. In particular, we discuss the relationship between the biology of aging and mechanisms of oral disease. We also present a framework for defining and utilizing age-appropriate rodents and present experimental design considerations, such as the number of age-points used and the importance of genetic background. While focused primarily on rodent models, alternative animal models that may be particularly useful for studies of oral health during aging, such as companion dogs and marmoset monkeys, are also discussed. We hope that such information will aid in the design of future preclinical studies of geriatric dental health, thus allowing more reliability for translation of such studies to age-associated oral disease in people.

Definitions and Epidemiology of Endodontic Infections

Purpose of Review

This review describes the recent findings from epidemiological studies on endodontic infections. The recent literature was screened for studies on the prevalence of primary apical periodontitis and posttreatment apical periodontitis in various populations.

Recent Findings

Twenty-nine articles reporting data on the prevalence of primary or posttreatment apical periodontitis from all over the world were included. The prevalence of apical periodontitis varied between 7 and 86%, while that of posttreatment apical periodontitis varied between 10 and 62%. The quality of the coronal restoration and the root filling appears to be the major predictors of apical periodontitis.

Summary

The recent findings from epidemiological studies on the prevalence of primary and posttreatment apical periodontitis in various populations are not substantially different from those from earlier years. It appears that the health of periapical tissues has not majorly improved in the general population.

Vitamin D and neurocognitive function

In recent years, emerging evidence has linked vitamin D not only to its known effects on calcium and bone metabolism, but also to many chronic illnesses involving neurocognitive decline. The importance of vitamin D₃ in reducing the risk of these diseases continues to increase due to the fact that an increasing portion of the population in developed countries has a significant vitamin D deficiency. The older population is at an especially high risk for vitamin D deficiency due to the decreased cutaneous synthesis and dietary intake of vitamin D. Recent studies have confirmed an association between cognitive impairment, dementia, and vitamin D deficiency. There is a need for well-designed randomized trials to assess the benefits of vitamin D and lifestyle interventions in persons with mild cognitive impairment and dementia.

Study of temporomandibular joint disorder in older patients by magnetic resonance imaging

OBJECTIVES

To compare characteristics in older patients in a sample of the general population of those with temporomandibular joint disorder (TMJD).

MATERIALS AND METHODS

A prospective study was carried out between 2001 and 2008 in patients with TMJD. The whole sample consisted of 141 patients divided in two groups: 31 patients aged over 60 (median age 67.9, ranging from 60 to 82) and the remaining 110 patients (median age 36.3, ranging from 12 to 59) who were seeking treatment. Clinical diagnostics was confirmed by MRI. Pain intensity was rated on a visual analogue scale (VAS 0-10).

RESULTS

There was no statistical difference between average pain in older patients (6.2) and patients aged up to 59 (5.7) evaluated by VAS. There was a statistically significant difference (p = 0.002) in pain duration: older patients reported shorter duration of experienced pain (7.8 months) than patients aged up to 59 (12.2 months).

CONCLUSION

In this study, it was found that 22% were older patients with TMJD. A higher level of anxiety was shown in both patients' groups, regardless of shorter pain experience in the older patients.

Demographic and behavioural profiles of patients with common oral mucosal lesions by a homogeneity analysis

OBJECTIVE

The aim of this study is to assess the main oral mucosal lesions (OMLs) within a hospital base and to provide an anamnestic, diagnostic model based on homogeneity analysis of some variables.

METHODS

The demographic and behavioural data (i.e. gender, age, smoking status, alcohol consumption and therapeutic drug usage) of 1753 patients with at least one OML were considered. Multiple correspondence analysis (MCA) and multivariate tests of the simultaneous marginal homogeneity hypothesis (SMH) were used to analyse the evidence of any differences between the demographic and behavioural profiles relating to OMLs diagnoses. Statistical significance of P < 0.05 was chosen.

RESULTS

With respect to the model used, patients affected by oral squamous cell carcinoma (n = 65; 3.5%) and oral leukoplakia (n = 73; 4.0%) differed significantly for demographic and behavioural characteristics analyzed, in particular with respect to gender (63.9%vs 50.1% males) and alcohol consumption (29.1%vs 12.1%). Patients affected by burning mouth syndrome (n = 134; 7.3%) and bisphosphonate-related osteonecrosis of the jaw (n = 40; 2.2%) differed significantly for chronic use of drugs (45.7%vs 71.6%). Finally, patients with halitosis (n = 60; 3.3%) and recurrent aphthous stomatitis (n = 103; 5.6%) showed similar profile, mainly in terms of men (47.6%), drinker (4.8%), drug user (34.9%), ≥60 years old (20.8%) and smoker (6.4%).

CONCLUSION

Knowledge of some similarities in patients' profile could help in positing the likely presence of OML when making diagnosis process by either general physicians or dentists, especially those without extensive experience in the field of oral medicine.