A study to evaluate the frequency and association of various mucosal conditions among geriatric patients

Dental education and practice: past, present, and future trends

This position paper explores the historical transitions and current trends in dental education and practice and attempts to predict the future. Dental education and practice landscape, especially after the COVID-19 epidemic, are at a crossroads. Four fundamental forces are shaping the future: the escalating cost of education, the laicization of dental care, the corporatization of dental care, and technological advances. Dental education will likely include individualized, competency-based, asynchronous, hybrid, face-to-face, and virtual education with different start and end points for students. Dental practice, similarly, will be hybrid, with both face-to-face and virtual opportunities for patient care. Artificial intelligence will drive efficiencies in diagnosis, treatment, and office management.

Is there any difference based on sublingual varices frequency between hypertensive patients and healthy persons?

BACKGROUND

Sublingual varices (SV) are benign vascular lesions that have questionable associations with aging, smoking, and hypertension. This study purposed to evaluate whether SV frequency differs between hypertensive patients and healthy persons.

METHODS AND MATERIAL

This cross-sectional study was conducted on 120 dental patients referred to Yazd Oral Medicine Department. At first sublingual surface of the tongue were examined before the routine oral survey, and blood pressure (BP) was measured in a sitting position. SV were classified into Grade 1 (no/mild), Grade 2 (medium to severe), and Grade 3 (multi-focal). Blood pressure was measured in all participants. Participants based on the obtained BP, divided into normal, prehypertension, stage 1, and 2 groups. Frequency of SV was compared in regarding age, gender, and stage of hypertension. All of the analyses were conducted at a p < 0.05 level of significance by the SPSS22 statistical package using chi-square test.

RESULTS

Out of 120 patients, 84 (70%) had SV. The frequency of SV in patients with hypertension (HT) (86.8%) was significantly higher than in others (48.1%); (p < 0.001). Data analysis showed there was a significant difference between the age groups. There was no significant difference based on SV between two genders. There was no significant difference in the frequency of sublingual varices between males and females. Aging could impact the frequency of SV.

CONCLUSION

This study revealed that patients with hypertension had more SV. A simple valuable method for dental clinicians to be active in preventive health care is evaluating sublingual surface of tongue.

Caregiver burden in older Indian patients with cancer- Experience from a tertiary care center

INTRODUCTION

Most of the long-term care for older adults with chronic or debilitating illnesses is provided by unpaid family members or informal caregivers. There is limited information on caregiver burden among caregivers of older patients with cancer in India. Hence, we assessed the prevalence and severity of caregiver burden among caregivers of older Indian patients with cancer.

METHODS

This was an observational study conducted at the geriatric oncology clinic at Tata Memorial Centre, Mumbai, India. Caregivers of patients aged 60 years and over with a diagnosis of cancer were assessed for caregiver burden using the Zarit Burden Interview. Descriptive statistics were used for demographic and clinical variables. Factors impacting caregiver burden were analyzed using multiple linear regression analysis.

RESULTS

Caregiver burden was assessed among 127 caregivers of older Indian patients with cancer. The median patient age was 69 years (range 60-90). Most patients were men (75.6%). There were 33 female caregivers (26%), and 94 male caregivers (74%). The median caregiver burden score was 12 (IQR 6-20). Caregiver burden was "little/none" in 97 (76.4%), "mild-moderate" in 25 (19.7%), "moderate-severe" in four (3.1%) and "severe" in one (0.8%) of the caregivers assessed. On multivariate analysis, factors that significantly impacted caregiver burden scores were the presence of psychological issues in the patient and the caregiver's educational level.

CONCLUSION

Caregiver burden was low among caregivers of older Indian patients with cancer seen at a single center. Caregivers of patients with psychological disorders, and those who had less schooling reported higher caregiver burden.

Denture-related problems of patients in acute geriatric care

BACKGROUND

With increasing frailty and complaint-oriented utilization of dental care, the prevalence of oral diseases also increases.

AIM

To clarify whether there is a need for dental prosthodontic treatment during residential acute geriatric rehabilitation.

METHODS

Within 3 weeks in a hospital for acute geriatric patients, 79 out of 157 newly admitted patients were interviewed as study participants (age: median 79.0 years, range 66-96 years, female 51.9%), dental findings were recorded, treatment needs were determined but X‑rays were not taken.

RESULTS

Of the participants 31.1% had not seen a dentist for more than 1 year and 18.2% were edentulous. The median number of teeth in dentate participants was 16 (range 1-28 teeth); based on all participants, there was a median of 12.0 teeth (range 0-28 teeth). Of the 52 denture wearers (45 upper jaw and 43 lower jaw), 5 each of the maxillary and mandibular dentures could not be assessed because they were not available at the hospital. Moderate denture deficiencies were present in 62.5% of participants wearing upper dentures (mandibular 55.3%).

CONCLUSION

Dental treatment is needed in this vulnerable patient group. Therefore, the oral cavity should be assessed as part of the geriatric assessment. The available data confirm that the use of validated assessment instruments, such as the mini dental assessment as part of the comprehensive geriatric assessment would be useful. In addition to an oral examination, simple dental treatment should be provided to reduce infections and improve chewing ability. The geriatrician should be informed of the urgency of treatment. The overall rehabilitative approach of acute geriatric treatment would be complete if oral health would not be excluded.

[Dental care for older people: opportunities and challenges]

Die Mundgesundheit der Bevölkerung in Deutschland konnte in den letzten Jahren verbessert werden; allerdings profitierten ältere und insbesondere gebrechliche sowie pflegebedürftige Menschen nicht adäquat von dieser Entwicklung. Dabei kann eine gute Mundgesundheit relevant dazu beitragen, die Herausforderungen bei Gebrechlichkeit und Pflegebedürftigkeit besser zu bewältigen. Der eingeschränkte Zugang zur zahnmedizinischen Betreuung, die manchmal eingeschränkte Kooperativität sowie die schlechtere Mundpflege in dieser Bevölkerungsgruppe erhöhen das Risiko für Karies, Parodontalerkrankungen, Zahnverlust und Zahnlosigkeit im Vergleich zur Durchschnittsbevölkerung.

Der vorliegende Beitrag gibt eine Übersicht über die zahnmedizinische Situation älterer Menschen anhand bereits publizierter Daten aus der bevölkerungsrepräsentativen Fünften Deutschen Mundgesundheitsstudie (DMS V), die im Jahr 2014 erhoben wurden. Die mittlere Anzahl der fehlenden Zähne betrug bei den 65- bis 74-Jährigen 11,1 Zähne. Bei älteren Seniorinnen und Senioren (75–100 Jahre) mit Pflegebedarf (äSmP) war die Mundgesundheit schlechter als bei denjenigen ohne Pflegebedarf (äSoP). So hatten äSoP durchschnittlich 11,8 Zähne, äSmP dagegen nur 5,7 Zähne. Der Anteil zahnloser 65- bis 74-Jähriger hatte sich seit 1997 halbiert auf 12,4 %. Bei den äS waren 32,8 % zahnlos (äSmP: 53,7 %, äSoP: 26,7 %). Mehr als 75 % der äSmP waren abnehmbar prothetisch versorgt (äSoP: 51,7 %). Vor diesem Hintergrund werden in diesem Beitrag Schnittstellen benannt, an denen eine chancengleiche Anbindung dieser Bevölkerungsgruppen an eine zahnmedizinische Versorgungsstruktur etabliert werden könnte. Diese beinhalten akutgeriatrische Krankenhausstationen und die Entwicklung weitergehender Konzepte in der aufsuchenden Versorgung zur besseren Versorgung der Betroffenen und zur Erleichterung der Pflege.

Denture induced mechanotransduction can contribute to oral carcinogenesis

Mechanical stresses in the form of substrate rigidity, hydrostatic pressure, compressive, tensile and shear stress has been regarded as an important motive for the epithelial carcinogenesis brought about by the activation of Hippo signaling pathways. Masticatory forces generated in edentulous patients with dentures are transferred directly to the palatal mucosa (maxillary denture) and alveolar mucosa (mandibular denture). Thus, the oral mucosa present underneath the dentures experiences compressive, shear and tensile stresses on a day-to-day basis. These stresses can induce carcinogenesis by mechano-transduction and subsequent activation of numerous carcinogenesis relevant signaling pathways such as the HIPPO pathway. With this contention in mind, we proposed a hypothesis, which explains the pathogenesis for the presence of oral squamous cell carcinoma in denture wearer patients. Efforts were made to envisage the appropriate experimentations for the evaluation of the hypothesis. As a therapeutic implication, flexible dentures, soft denture, or medicated dentures could be prescribed for the high-risk groups having potentially malignant lesions in the oral cavity.

Stomatological disorders in older people: An epidemiological study in the Brazil southern

BACKGROUND

The aim of this retrospective, cross-sectional and observational study was to perform a survey of the stomatological conditions of elderly patients seen in a period of 40 years at a Stomatology Service in Southern Brazil.

MATERIAL AND METHODS

A total of 24,347 medical records were reviewed, of which 5,063 belonged to elderly patients aged 60 to 97 years. The stomatological conditions, systemic conditions, and smoking and alcohol drinking habits as well were recorded.

RESULTS

The mean age of the patients was 69.29 years, 67.1% were female and 32.9% were male. Variations of normality accounted for 44.5% of the cases. The most prevalent disorders were fungal infections (26.1%), reactive inflammatory lesions (24.6%), burning mouth syndrome (14.9%), benign neoplasms (12.4%), autoimmune disorders (12.3%), premalignant lesions (10.2%) and malignant epithelial neoplasms (7.2%). Regarding biopsied lesions, squamous cell carcinoma was the most prevalent at 30.2%, followed by hyperplasic lesions (28.2%).

CONCLUSIONS

Knowledge of these physiological and pathological conditions in the oral cavity of the older people is essential for early diagnosis and preventive and therapeutic measures when necessary.

Epidemiology of oral mucosal lesions in Slovenia

Background

Among the diseases of oral mucosa, malignant tumors are the most dangerous, but not the most common lesions that might appear in the oral cavity. Since most of the studies are focused on the detection of cancer in the oral cavity, we were interested in detecting the frequency of benign changes of the oral mucosa in Slovene population. Oral mucosal lesions are important pointer of oral health and quality of life, especially in elderly. The prevalence of oral mucosal lesions, together with information on the risk habits associated with oral health, such as tobacco and alcohol use, can help in planning future oral health studies and screening programs.

Patients and methods

Survey upon oral mucosal lesions was conducted during the national project for oral cancer screening in spring 2017 in the Slovenia in which more than 50% of dentists participated and 2395 patients (904 men and 1491 women) were included.

Results

Clinical examination, which was conducted according to the WHO standards revealed that 645 patients (27%) had oral mucosal lesions. The ten most common oral lesions detected were fibroma, gingivitis, Fordyce spots, white coated tongue, cheek biting, linea alba, denture stomatitis, geographic tongue, recurrent aphthous ulcerations and lichen planus.

Conclusions

Overall, these epidemiological data suggest need for specific health policies for prevention, diagnosis and treatment of oral mucosal lesions.

Oral squamous cell carcinoma misdiagnosed as a denture-related traumatic ulcer: A clinical report

A 65-year-old woman presented with an ulcerated lesion in the alveolar ridge mucosa, which appeared after new dentures had been inserted. Despite many treatment attempts, the lesion did not recede, even with the interruption of denture wearing. A biopsy was performed, and histopathologic examination revealed an ulcerated, invasive, poorly differentiated oral squamous cell carcinoma. The time from the patient's first contact with the prosthodontist because of the lesion until the appropriate diagnosis was established was approximately 6 months. This clinical report documents a significant delay in the oral squamous cell carcinoma diagnosis and treatment because of a clinical misdiagnosis of a traumatic ulcer resulting from complete dentures. Prosthodontists should be aware of the importance of early diagnosis of oral cancer among elderly prosthesis wearers.

Oral mucosal lesions in elderly dental patients in Sana'a, Yemen

OBJECTIVES

With aging, the oral mucosa becomes more susceptible to external stimuli. The aims of this study were to obtain baseline data on the prevalence of oral mucosal lesions (OMLs) in a population of elderly Yemeni patients and to investigate differences in the presentation of these findings in relation to age, gender, education level, and the wearing of dentures.

PATIENTS AND METHODS

The prevalence of OMLs was assessed by clinical examination of a sample of 310 elderly Yemeni patients aged 60 years and older. A single examiner performed detailed oral examinations of the oral cavity according to international criteria and the World Health Organization codes.

RESULTS

The overall prevalence of OMLs was 77.1%, with a significant difference (P < 0.05) between men (80.3%) and women (69.6%). The prevalence rate of OMLs indicated a significant decrease with advancing age. The most frequently observed lesions were fissured tongue (34.2%), benign tumors (17.1%), hairy tongue (16.5%), and qat-induced white lesions (12.6%). Hairy tongue, qat-induced white lesions, and shammah keratosis were associated with men (P < 0.01, P < 0.05, and P < 0.05, respectively), whereas geographic tongue was associated with women (P < 0.05). The presence of one or more lesions was significantly associated with low education level (P < 0.05). Certain OMLs showed a significant association with smoking and qat chewing (P < 0.05). No association was found between the occurrence of OMLs and denture wearing (P > 0.05).

CONCLUSIONS

The present study has shown a high prevalence of oral lesions among Yemeni elders.