Evaluation of a Nystatin-Containing Mouth Rinse for Terminally Ill Patients in Palliative Care

Purpose

To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care.

Materials and Methods

52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days’ incubation at 37°C.

Results

Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p<0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores.

Conclusions

No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.

The Danish HD Registry-a nationwide family registry of HD families in Denmark

The Danish Huntington's Disease Registry (DHR) is a nationwide family registry comprising 14 245 individuals from 445 Huntington's disease (HD) families of which the largest family includes 845 individuals in 8 generations. 1136 DNA and/or blood samples and 18 fibroblast cultures are stored in a local biobank. The birthplace of the oldest HD carrier in each of the 261 families of Danish origin was unevenly distributed across Denmark with a high number of families in the middle part of the peninsula Jutland and in Copenhagen, the capital. The prevalence of HD in Denmark was calculated to be 5-8:100 000. 1451 individuals in the DHR had the size of the HTT CAG repeat determined of which 975 had 36 CAG repeats or more (mean ± SD: 43,5 ± 4,8). Two unrelated individuals were compound heterozygous for alleles ≥36 CAGs, and 60 individuals from 34 independent families carried an intermediate allele.

Sex hormone manipulation slows reaction time and increases labile mood in healthy women

BACKGROUND

Women show increased risk of depressive symptoms in life phases where ovarian steroid hormone levels fluctuate or decline rapidly. The risk mechanisms may include changes in mental state and affective cognition possibly mediated by serotonergic neurotransmission.

METHODS

In a randomized controlled double-blinded trial, 61 healthy women (mean age 24.3±4.9 years) were tested with measures of affective verbal memory, reaction time, mental distress, and serotonin transporter binding at baseline and at follow-up after receiving gonadotropin-releasing hormone agonist (GnRHa) or placebo intervention. Women also reported daily mood profiles during intervention. We tested direct effects of intervention and indirect effects through changes in serotonin transporter binding on verbal affective memory, simple reaction time and self-reported measures of mental distress, and further effects of GnRHa on daily mood.

RESULTS

GnRHa induced an increase in simple reaction time (p=0.03) and more pronounced fluctuations in daily self-reported mood in a manner dependent on baseline mood (p=0.003). Verbal affective memory recall, overall self-perceived mental distress, and serotonin transporter binding were not affected.

CONCLUSIONS

In healthy women transient sex-steroid hormone fluctuations decrease speed of information processing and further produce more labile mood only in women with elevated levels of mood disturbances at baseline.

Ubiquitin: a potential cerebrospinal fluid progression marker in Huntington's disease

BACKGROUND

Finding early and dynamic biomarkers in Huntington's disease is a key to understanding the early pathology of Huntington's disease and potentially to tracking disease progression. This would benefit the future evaluation of potential neuroprotective and disease-modifying therapies, as well as aid in identifying an optimal time point for initiating a potential therapeutic intervention.

METHODS

This explorative proteomics study evaluated cerebrospinal fluid from 94 Huntington's disease gene-expansion carriers (39 premanifest and 55 manifest) and 27 Huntington's disease gene-expansion negative individuals using surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry. Differences in peak intensity from SELDI-TOF spectra were evaluated.

RESULTS

Levels of 10 peaks were statistically significantly different between manifest gene-expansion carriers and controls. One of them identified as ubiquitin was shown to be dependent on the Unified Huntington Disease Rating Scale Total Functional Capacity, a pseudo-measure of disease severity (P = 0.001), and the Symbol Digit Modalities Test (0.04) in manifest and CAG-age product score (P = 0.019) in all gene-expansion carriers.

CONCLUSIONS AND RELEVANCE

Multiple studies have shown that the ubiquitin-proteasome system is involved in Huntington's disease pathogenesis and understanding of this involvement may have therapeutic potential in humans. This is the first study on cerebrospinal fluid to confirm the involvement of the ubiquitin-proteasome system in Huntington's disease. Furthermore it is shown that ubiquitin increases with disease progression and CAG-age product score and therefore may have the potential as a Huntington's disease progression marker, also prior to motor onset.

NIPA1 mutation in complex hereditary spastic paraplegia with epilepsy

BACKGROUND AND PURPOSE

  Hereditary spastic paraplegia (HSP) is a group of clinically and genetically heterogeneous neurodegenerative disorders characterized in the 'pure' phenotype by progressive spasticity and weakness of the lower limbs. In the 'complex' phenotype, additional neurologic symptoms or signs are found. Mutations in the NIPA1 gene have been reported to cause spastic paraplegia type 6 (SPG6) in 10 families. SPG6 is a rare form of autosomal dominantly inherited HSP associated with a pure phenotype; however, in one complex SPG6 family, idiopathic generalized epilepsy (IGE) has been described and in addition, recurrent microdeletions at 15q11.2 including NIPA1 have been identified in patients with IGE. The purpose was to identify NIPA1 mutations in patients with pure and complex HSP.

METHODS

  Fifty-two patients with HSP were screened for mutations in NIPA1.

RESULTS

  One previously reported missense mutation c.316G>A, p.Gly106Arg, was identified in a complex HSP patient with spastic dysarthria, facial dystonia, atrophy of the small hand muscles, upper limb spasticity, and presumably IGE. The epilepsy co-segregated with HSP in the family.

CONCLUSION

  NIPA1 mutations were rare in our population of patients with HSP, but can be found in patients with complex HSP. Epilepsy might be more common in SPG6 than in other forms of HSP because of a genetic risk factor closely linked to NIPA1.

Surveillance in von Hippel-Lindau disease (vHL)

von Hippel-Lindau disease (vHL) is a hereditary multisystem cancer syndrome requiring lifelong prophylactic surveillance. Current surveillance recommendations rely on best medical judgement and no evidence of effect exists. We aimed to evaluate the capability of surveillance in manifestation detection, before these turn symptomatic, in order to prevent disabling or even fatal outcomes. We focus on surveillance of central nervous system (CNS) hemangioblastomas, retinal hemangiomas and renal cell carcinoma (RCC) as these have the most severe consequences. On the basis of full medical records from 54 living vHL-mutation carriers, risks of intercurrent manifestations in-between surveillance examinations were determined and clinical consequences of surveillance findings evaluated. Current recommendations of annual ophthalmic and abdominal examinations corresponded to acceptably low intercurrent manifestation risks (1.7% and 1.2%, respectively), whereas recommendations of biennial CNS imaging corresponded to a risk of 7.2%. Annual CNS examinations, however, significantly reduces this risk to 2.7%. Furthermore, most CNS manifestations found due to surveillance (71%, 106 of 150) had clinical consequence for the patient. Also, pre-symptomatic surveillance increased cumulative incidence of clinical vHL diagnosis from 46% to 72% and from 89% to 94% by age 30 and 50 years, respectively. The present results promote optimization of surveillance, expectantly improving clinical vHL outcomes.

Predictors of ovarian response in intrauterine insemination patients and development of a dosage nomogram

The objective of this prospective study was to identify predictors of ovarian response in ovulatory patients treated with low-dose recombinant FSH (rFSH), gonadotrophin-releasing hormone antagonist and intrauterine insemination (IUI), and to develop an rFSH dosage nomogram based on the findings. Patients (n = 159) were stimulated with a starting dose of 75 IU rFSH/day. Ten parameters were investigated as possible predictors of the number of mature follicles >or=15 mm: age, spontaneous cycle length, body weight, body mass index, smoking status, total ovarian volume, total number of antral follicles, total Doppler score of the ovarian stromal blood flow, baseline FSH and oestradiol. Simple and multiple linear regressions were used for the statistical analysis. Appropriate ovarian response was defined as two to three mature follicles. Body weight (P = 0.001) and the number of antral follicles (P = 0.004) were the strongest independent predictive factors of the number of mature follicles. In conclusion, body weight and antral follicle count may be used to achieve appropriate ovarian response for IUI in ovulatory patients. Based on this, a simple rFSH dosage nomogram was developed for individual ovarian stimulation prior to IUI.

Restorative caries therapy in nursing home residents using composite resins and compomers without a rubber dam

OBJECTIVE

This study was designed to investigate the prognosis of restorative caries therapy applied in nursing home residents.

METHOD AND MATERIALS

In 25 consecutive patients a total of 42 restorations were placed, 23 of composite resin (APX/SE Bond) and 19 of compomer (Dyract). The working conditions, such as patient cooperation, quantity of saliva, location of cavity margins, cavity size, and gingival inflammation, were evaluated prior to treatment. The restorations were evaluated qualitatively at baseline, after 6 months, and after 12 months.

RESULTS

At 12 months, all examined restorations were clinically acceptable (6 patients had died). There was no significant difference between the quality of the restorations in composite resin and compomer. The plaque scores increased significantly during the study period.

CONCLUSIONS

The study showed that, within the limitation of a short-term follow-up, restorative caries therapy using composite resin or compomer was successful in nursing home residents although rubber dam was not used.

Indications for removable partial dentures: a literature review

PURPOSE

The purpose of this report was to evaluate indications for the use of removable partial dentures based on a comprehensive literature review.

MATERIALS AND METHODS

Using a model similar to a Delphi process, the literature relating to the indications and contraindications for the prescription of removable partial dentures was discussed by seven experienced educators in a 2.5-day workshop.

RESULTS

Evidence for indications and contraindications for the prescription of removable partial dentures is not clearly stated in the literature; however, some basic principles are defined. There appears to be a trend in favor of the use of the shortened dental arch concept or implant-supported restorations instead of conventional removable partial dentures, given the evidence that the long-term use of removable dentures is associated with increased risks of caries and periodontitis and low patient acceptance. The presence of sound abutment teeth appears to encourage the use of removable partial dentures, as the fixed partial denture alternative requires sacrifice of healthy hard tissues. When economic factors influence the decision-making process, removable partial dentures are often chosen.

CONCLUSION

While evidence-based indications and contraindications for prescribing removable partial dentures are still lacking, major underlying principles for clinical decision making are identified.

The advantages of occupational therapy in oral hygiene measures for institutionalised elderly adults

OBJECTIVE

To investigate a new method in teaching and supervising tooth and denture brushing activities by employing occupational therapy techniques.

MATERIALS AND METHODS

Sixty-one residents, 44 women and 17 men, with an average age of 85.7 +/- 6.6 years (range 72-97 years) living in a Long-Term Care home (LTC) in Geneva were enrolled in a randomised controlled trial. They were divided at random into experimental (EG) and control groups (CG) with matched age and sex distribution. Two subjects passed away during the 3-month experimental period. Following medical history, plaque scores and tooth brushing habits were evaluated within the context of a comprehensive clinical assessment. Furthermore, a Mini Mental State and a vision test were taken. Based on the results of these health assessments both the EG and the CG were divided into an 'assisted' (IA) and an 'independent' (II) subgroup. In the EG, tooth brushing was initially taught and in the IA monitored and re-educated once a week by an occupational therapist. In contrast, the CG-IA group received a weekly placebo activity such as manicure by the same person.

RESULTS

From the individual movements taught and monitored by the occupational therapist, opening a tube of toothpaste (n.s.) and denture brushing (p < 0.05) were performed more independently after 3 months. Both the occupational therapy and the placebo activity led to a significant improvement in oral (p < 0.01 and 0.05) and in denture hygiene (p < 0.001 and 0.05). From all participants, the EG-IA subgroup presented the most significant amelioration in plaque (p < 0.01) and denture hygiene scores (p < 0.001). This group consisted mostly of subjects with an impaired cognitive state.

CONCLUSIONS

Despite the marked placebo effect, the results indicate that occupational therapy is particularly useful to improve the oral and denture hygiene in dependent and cognitively impaired LTC residents and may promote their autonomy in the execution of activities of daily life such as denture brushing.

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania

OBJECTIVE

The aim of this study was to describe the oral health status of older adults living in northeastern Germany.

MATERIALS AND METHODS

Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross-sectional, population-based study. Data on 1446 subjects aged 60-79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss.

RESULTS

The prevalence of edentulousness varied from 16% in the 60-65-year-old group to 30% in the 75-79-year-old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60-65 years) to one in the oldest (75-79 years). Among subjects aged 60-69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70-79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70-79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60-69 years: 85% vs. 71% in 70-79-year-old men; women aged 60-69 years: 71% vs. 62% in 70-79-year-olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern.

CONCLUSIONS

It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.

Evaluation of a nystatin-containing mouth rinse for terminally ill patients in palliative care

PURPOSE

To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care.

MATERIALS AND METHODS

52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days' incubation at 37 degrees C.

RESULTS

Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p < 0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores.

CONCLUSIONS

No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.

Study of Health in Pomerania (SHIP): Relationship among socioeconomic and general health factors and dental status among elderly adults in Pomerania

OBJECTIVE

The aim of this study was to evaluate associations among the dental status, socioeconomic factors, and general health of 1,877 subjects between the ages of 55 and 79.

METHOD AND MATERIALS

Socioeconomic information (age, sex, education level) and questions on smoking and alcohol abuse were taken from an interview; income and medical information (number of diseases) were taken from a self-administered questionnaire; and HbA1C and CDT (diabetes and alcoholism markers) were taken from blood analyses.

RESULTS

Of the subjects, 73% had a low education level, and 27% of the subjects had a monthly income of < 1,000 Euro and 13% of > 2,000 Euro. Twenty-six percent of the subjects were edentulous, and 29% had 20 or more teeth. The odds ratio of edentulism increased to 9.0 (95% confidence interval = 7.0-11.5) at the ages of 75 to 79 years compared to ages 55 to 79. Logistic regression analyses showed that edentulism was significantly associated with age, low education level, low income, smoking, and alcohol abuse. However, the retention of more than 20 teeth was associated with age.

CONCLUSIONS

Age, low income, low education level, smoking, and alcohol abuse seemed to be risk markers for edentulism; whereas, the number of diseases, diabetes, and gender were not.

Prosthodontic status among old adults in Pomerania, related to income, education level, and general health (results of the Study of Health in Pomerania, SHIP)

PURPOSE

The aim of the study was to evaluate associations among prosthetic status, socioeconomic factors, and general health of subjects aged 55 to 79 years. The data were taken from the Study of Health in Pomerania (SHIP).

MATERIALS AND METHODS

Socioeconomic information (age, sex, education level), medical information (number of diseases), and details on smoking and alcohol consumption were obtained. Prosthetic status in the maxilla and mandible was classified into complete denture (CD), removable partial denture (RPD), > or = 10 natural teeth or teeth replaced with fixed prosthodontics (10T+), and < or = nine natural teeth including fixed prosthodontics (9T-).

RESULTS

The data of 1,877 subjects were evaluated. CDs in the maxilla were more frequent than in the mandible. RPDs were more frequent in the mandible and in the group aged 65 to 74 years. Of the individuals with a low education level, 47% had a CD in the maxilla, and only 21% had 10T+. However, of subjects with a high education level, 22% had a CD in the maxilla, and 54% had 10T+. The odds ratio of having a CD in the maxilla increased to 11.9 at the age of 75 to 79 years, compared to 0.6 at the age of 55 to 59 years. Logistic regression analyses showed that the risk of wearing a CD was significantly associated with old age, low education level, low income, smoking, and alcohol abuse, whereas the number of diseases (used as an indicator of general health) was not.

CONCLUSION

Alcohol abuse, smoking, low education level, low income, and old age were significant predictors of wearing CDs.

Bronchopneumonia and oral health in hospitalized older patients. A pilot study

AIMS

To correlate microbial findings obtained by bronchoalveolar lavage in pneumonia patients with the clinical situation of the oral cavity.

METHOD

Quantitative aerobic and anaerobic cultures were carried out in 150 ml samples of bronchoalveolar lavage (BAL) obtained by means of an endoscope (Video Endoscope Pentax) inserted per os in the infected bronchus.

MATERIAL

Twenty consecutive patients with a tentative clinical diagnosis of bronchopneumonia in whom BAL was carried out for diagnostic purposes. A clinical evaluation of the oral health status (oral hygiene, caries, periodontal diseases) was subsequently carried out.

RESULTS

In seven edentulous subjects wearing complete dentures the culture of anaerobic microorganisms was negative or yielding less than 100 cfu/ml BAL. Two patients yielded high counts of S. aureus and one high counts of P. aeruginosa. In the 13 subjects with natural teeth left one showed high counts of Veillonella spp. (anaerobic) + P. aeruginosa, one high counts of Veillonella spp. + S. aureus, one high counts of P. aeruginosa + S. aureus and one high counts of E. coli. These four subjects showed poor oral hygiene, periodontal pockets and a BAL microflora consistent with periodontal pathology.

CONCLUSION

The results of this pilot study suggest that microorganisms of denture plaque or associated with periodontal diseases may give rise to aspiration pneumonia in susceptible individuals.

Nutrition and oral health

Reduced chewing function in community-dwelling older people with adequate general health is linked to having fewer than 20 teeth present or to wearing removable dentures. By chewing for longer periods of time or swallowing larger food particles they are normally able to compensate for the impaired function. The masticatory function can be restored by adequate prosthetic therapy, which results in increased activity of the masticatory muscles during chewing and reduces the chewing time and the number of chewing strokes until swallowing. In frail or dependent elderly people undernutrition is prevalent because of health problems, reduced appetite and poor quality of life. Poor oral health and xerostomia are often associated with a reduced body mass index and serum albumin level and the avoidance of difficult-to-chew foods. Maintenance or re-establishment of masticatory function is an integral part of the medical health care of these patients, with the aim of improving their nutritional status and quality of life.

[Periodontal status among the population of Geneva, Vaud and Neuchâtel]

The aim of the present study was to evaluate the periodontal status among the population of Geneva, Vaud and Neuchâtel. A representative sample of the population was selected on the basis of age, sex and location. The rate of participation was 51%. In total, 268 subjects were examined; this corresponds to 1:4000 inhabitants. The results showed that a majority of the subjects presented signs of inflamed gingiva. Moderate periodontitis affected a large proportion of the population, whereas severe periodontitis affected only a small percentage of subjects. We observed that the severity of periodontal destruction increased with age and there was no difference between both sexes. The findings revealed that most of the periodontal treatment needs could be provided by general dentists. Complex treatment needs were limited in extent.

Benchmark dose calculation from epidemiological data

A threshold for dose-dependent toxicity is crucial for standards setting but may not be possible to specify from empirical studies. Crump (1984) instead proposed calculating the lower statistical confidence bound of the benchmark dose, which he defined as the dose that causes a small excess risk. This concept has several advantages and has been adopted by regulatory agencies for establishing safe exposure limits for toxic substances such as mercury. We have examined the validity of this method as applied to an epidemiological study of continuous response data associated with mercury exposure. For models that are linear in the parameters, we derived an approximative expression for the lower confidence bound of the benchmark dose. We find that the benchmark calculations are highly dependent on the choice of the dose-effect function and the definition of the benchmark dose. We therefore recommend that several sets of biologically relevant default settings be used to illustrate the effect on the benchmark results and to stimulate research that will guide an a priori choice of proper default settings.

Neurobehavioral deficits associated with PCB in 7-year-old children prenatally exposed to seafood neurotoxicants

Prenatal exposure to polychlorinated biphenyls (PCBs) was examined by analysis of cord tissue from 435 children from a Faroese birth cohort. Analysis of 50 paired cord blood samples showed excellent correlation with the cord tissue concentration (r=.90). Among 17 neuropsychological outcomes determined at age 7 years, the cord PCB concentration was associated with deficits on the Boston Naming Test (without cues, two-tailed P=.09 not adjusted for mercury; with cues, P=.03), the Continuous Performance Test reaction time (P=.03), and, possibly, on long-term recall on the California Verbal Learning Test (P=.15). The association between cord PCB and cord-blood mercury (r=.42) suggested possible confounding. While no PCB effects were apparent in children with low mercury exposure, PCB-associated deficits within the highest tertile of mercury exposure indicated a possible interaction between the two neurotoxicants. PCB-associated increased thresholds were seen at two of eight frequencies on audiometry, but only on the left side, and no deficits occurred on evoked potentials or contrast sensitivity. The limited PCB-related neurotoxicity in this cohort appears to be affected by concomitant methylmercury exposure.

Successful aging--the case for prosthetic therapy

Reduced chewing ability in community-dwelling older people is linked to the presence of removable dentures and having fewer than 20 natural teeth present. Compensation is provided by chewing longer and swallowing larger food particles. Replacement of posterior tooth loss by fixed or removable prostheses increases the activity of the masticatory muscles, and reduces chewing time and the number of chewing strokes until swallowing. In residents of nursing homes and long-term care facilities undernutrition is prevalent because of general medical problems, reduced appetite, and poor quality of life. Poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult-to-chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.

Aesthetic considerations for the treatment of partially edentulous patients with removable dentures

Treatment with removable partial dentures (RPDs) is an affordable solution for anterior or posterior tooth loss. In determining a proper treatment solution, it is important for the clinician to consider the patient's aesthetic expectations, socioeconomic situation, and the prognosis for the prosthesis and remaining dentition. This article presents guidelines to optimize the aesthetic result of this treatment and considers framework and clasp concepts; rotational path design; minimal extension of the denture bases; auxiliary attachments or retentive bars; and implants for retention and support of RPDs.

Interpreting parameters in the logistic regression model with random effects

Logistic regression with random effects is used to study the relationship between explanatory variables and a binary outcome in cases with nonindependent outcomes. In this paper, we examine in detail the interpretation of both fixed effects and random effects parameters. As heterogeneity measures, the random effects parameters included in the model are not easily interpreted. We discuss different alternative measures of heterogeneity and suggest using a median odds ratio measure that is a function of the original random effects parameters. The measure allows a simple interpretation, in terms of well-known odds ratios, that greatly facilitates communication between the data analyst and the subject-matter researcher. Three examples from different subject areas, mainly taken from our own experience, serve to motivate and illustrate different aspects of parameter interpretation in these models.

Maternal seafood diet, methylmercury exposure, and neonatal neurologic function

OBJECTIVE

To determine whether neonatal neurologic function is adversely affected by seafood contaminants from maternal diet during pregnancy.

STUDY DESIGN

One hundred eighty-two singleton term births were evaluated in the Faeroe Islands, where marine food includes pilot whale. Maternal serum, hair, and milk and umbilical cord blood were analyzed for contaminants. Levels of essential fatty acids, selenium, and thyroid hormones were determined in cord blood. Each infant's neurologic optimality score was determined at 2 weeks of age adjusted for gestational age, and predictors were assessed by regression analysis.

RESULTS

Exposures to methylmercury and polychlorinated biphenyls were increased in relation to maternal seafood intake, as were omega3 fatty acid concentrations in cord serum. Thyroid function was normal. After adjustment for confounders, a 10-fold increase of the cord-blood mercury concentration was associated with a decreased neurologic optimality score of 2.0 (P =. 03). This effect corresponds to a decrease in gestational age of about 3 weeks. Other indicators of the seafood diet had no effect on this outcome.

CONCLUSIONS

Prenatal exposure to methylmercury from contaminated seafood was associated with an increased risk of neurodevelopmental deficit. Thus in this North Atlantic population, methylmercury constituted an important neurologic risk factor, although effects of other seafood components were not detectable.

Effects of an oral health program on the occurrence of oral candidosis in a long-term care facility

OBJECTIVES

The aim was to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. Half of the residents were included in an experimental group which benefited from a preventive oral hygiene program including instruction of the carers and implementation of a recall program for professional oral hygiene care.

METHODS

Intraoral examinations and yeast cultures from the oral mucosa and the fitting denture surface were carried out at baseline and 18 months later. The outgrowth of yeast was estimated on Oricult-N dip slides using the scale: no growth; 1-20 colonies; 21-100 colonies; >100 colonies.

RESULTS

At baseline (n = 237) and at 18 months (n = 159) the experimental and the control groups were similar with regard to the residents' distribution by age, sex, dental and prosthetic status and prevalence of denture stomatitis. The 78 residents lost had the same baseline characteristics as the survivors, except for being older. In the experimental group the severity of the inflammation of the palate decreased (P = 0.005) as well as the prevalence of glossitis (P = 0.005). At baseline high yeast scores from the mucosa (>20) were observed in about 50% of the residents in the experimental as well as the control group. At 18 months this figure was 23.4% for the experimental and 48.7% for the control group (P = 0.001). There was also a reduction of the number of residents with positive cultures and the denture yeast scores at 18 months in the experimental group (P = 0.05).

CONCLUSIONS

This study has shown that the preventive program was effective in reducing the colonization of the oral mucosa and dentures by Candida and thereby improving the health of the oral mucosa.

Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians

Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized in 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 caregivers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority.

Relationship between oral health and nutrition in very old people

OBJECTIVE

To evaluate the relationship between oral health status and nutritional deficiency.

DESIGN

Cross-sectional clinical study.

SUBJECTS

324 institutionalized frail older adults (mean age 85).

MEASUREMENTS

Structured oral examination including an evaluation of mucosa, periodontal state, caries prevalence and denture quality. The nutritional status was assessed using serum albumin concentration and the body mass index. Physical dependence was assessed using the Barthel index. To identify oral health disorders associated with markers of malnutrition we performed the Pearson chi2 test separately for edentulous and dentate patients. Subjects with at least one of the identified oral disorders were classified as having compromised oral functional status.

RESULTS

About two-thirds of the subjects were functionally dependent and half had either a body mass index <21 kg/m2 or serum albumin <33 g/l. Among the edentulous, wearing dentures with defective bases or not wearing dentures at all were the factors most associated with malnutrition. In dentate subjects, corresponding identifiers were the number of occluding pairs of teeth (five or fewer, either natural or prosthetic), the number of retained roots (four or more), and the presence of mobile teeth. According to these criteria, 31% of the subjects had a compromised oral functional status. This was more frequently found in dependent subjects (37%) than semi-dependent subjects (18%; odds ratio, 2.6; 95% confidence interval, 1.4-4.8). Those with compromised oral functional status had a significantly lower body mass index and serum albumin concentration.

CONCLUSION

Specific detrimental oral conditions are associated with nutritional deficiency in very old people.

Methylmercury exposure biomarkers as indicators of neurotoxicity in children aged 7 years

The mercury concentration in blood or scalp hair has been widely used as a biomarker for methylmercury exposure. Because of the increased risks associated with exposures during prenatal and early postnatal development, biomarker results must be interpreted with regard to the age-dependent susceptibility. The authors compared regression coefficients for five sets of exposure biomarkers in 917 children from the Faroe Islands examined at birth, 1 year, and 7 years. Outcome variables were the results of neuropsychologic examination carried out in 1993-1994 at age 7 years. After adjustment for covariates, the cord-blood concentration showed the clearest associations with deficits in language, attention, and memory. Fine-motor function deficits were particularly associated with the maternal hair mercury at parturition. Mercury concentrations in the child's blood and hair at age 7 years were significant predictors only of performance on memory for visuospatial information. These findings emphasize the usefulness of the cord-blood mercury concentration as a main risk indicator. They also support the notion that the greatest susceptibility to methylmercury neurotoxicity occurs during late gestation, while early postnatal vulnerability is less, and they suggest that the time-dependent susceptibility may vary for different brain functions.

Evoked potentials in Faroese children prenatally exposed to methylmercury

A study of 7-year-old children from a fishing village on Madeira has suggested that latencies of evoked potentials may be delayed because of increased exposures to methylmercury during development. Data from a previously published prospective study in the Faroe Islands have therefore been reexamined. Because of changes in instrumentation, results obtained during the second year of examination were excluded. After this restriction, the results show significant mercury-associated delays of the peak III latency and the I-III interpeak latency of the auditory brainstem evoked potentials. Mercury concentrations in both maternal hair at parturition and in cord blood indicated this association, whereas no such relationship was apparent with the child's current hair-mercury concentration. Thus, in agreement with the findings from Madeira, a delay of the peak III latency of the brainstem auditory evoked potentials appears to serve as a marker of prenatal methylmercury toxicity from contaminated seafood.

Prenatal methylmercury exposure as a cardiovascular risk factor at seven years of age

Blood pressure in childhood is an important determinant of hypertension risk later in life, and methylmercury exposure is a potential environmental risk factor. A birth cohort of 1,000 children from the Faroe Islands was examined for prenatal exposure to methylmercury, and at age 7 years, blood pressure, heart rate, and heart rate variability were determined. After adjustment for body weight, diastolic and systolic blood pressure increased by 13.9 mmHg [95% confidence limits (CL) = 7.4, 20.4] and 14.6 mmHg (95% CL = 8.3, 20.8), respectively, when cord blood mercury concentrations increased from 1 to 10 microg/liter cord blood. Above this level, which corresponds to a current exposure limit, no further increase was seen. Birth weight acted as a modifier, with the mercury effect being stronger in children with lower birth weights. In boys, heart rate variability decreased with increasing mercury exposures, particularly from 1 to 10 microg/liter cord blood, at which the variability was reduced by 47% (95% CL = 14%, 68%). These findings suggest that prenatal exposure to methylmercury may affect the development of cardiovascular homeostasis.

Associations between self-assessed masticatory ability, nutritional status, prosthetic status and salivary flow rate in hospitalized elders

OBJECTIVES

To compare the association between self-assessed masticatory ability and nutritional status with general health status, salivary flow and dental/prosthetic status.

DESIGN

A questionnaire and a cross-sectional clinical investigation combined with a measurement of salivary flow rates.

SUBJECTS AND METHODS

A cohort of 99 elderly, non-psychiatric patients in a geriatric hospital; clinical examination to determine dental and prosthetic status, oral health and whole unstimulated (USFR) and stimulated (SSFR) salivary flow rates, examination of anthropometric measures, serum albumin level and body mass index (BMI); questionnaire designed to produce yes or no answers related to masticatory function, nutritional status, appetite and prosthesis function; mini mental score examination (MMES).

MAIN OUTCOME MEASURES

USFR, SSFR, BMI, anthropometric measures and serum albumin level; complaints related to appetite and xerostomia.

RESULTS

Mean age of the 99 patients was 82.5 +/- 4.04 with a MMES of > 21; 50% with malnutrition of severe or intermediate degree, and 86% with moderately or severely reduced serum albumin concentration; 55% reported recent loss of appetite and 52% had symptoms of oral dryness. Recent loss of appetite was associated with reduced serum albumin and complaints of dry mouth and lack of appetite was associated with BMI < 21, 10% weight loss during the preceding 6 months, SSFR < or = 0.5 ml min-1 and wearing dentures. Complaints on poor retention of the maxillary denture were associated with recent weight loss and SSFR < or = 0.5 ml min-1.

CONCLUSIONS

Malnutrition in hospitalized elders is primarily associated with recent loss or lack of appetite whereas complaints related to dentures are associated with poor denture quality.

Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility

The aim of this study was to evaluate clinically and microbiologically the effects of a preventive oral health program in a long-term care facility. A total of 116 dentate elderly residents agreed to participate, and half of them were included in an experimental group. Almost all of the residents were mentally or physically handicapped, and many were dependent on care-givers for daily living activities. Oral examination and microbiological sampling were performed at baseline and 18 months later. The experimental group benefited from a preventive program, including an oral hygiene course for the health care providers and regular recalls by dental hygienists of the residents. After 18 months, the plaque indices were statistically similar to those at baseline in both groups. Mutans streptococci counts and active root caries at 18 months were lower compared to baseline in the experimental group but did not change significantly in the control group. Thus, it seems that, while the preventive program failed to decrease plaque indices, it was effective in reducing mutans streptococci colonisation and caries prevalence.

Associations between malnutrition, poor general health and oral dryness in hospitalized elderly patients

OBJECTIVE

To obtain information about the possible relationship between symptoms and signs of oral dryness and malnutrition/poor general health in hospitalized older people.

DESIGN

A cross-sectional clinical investigation with measurements of unstimulated salivary flow rates (USFR), stimulated salivary flow rates (SSFR), nutritional status, serum albumin concentration and an evaluation of symptoms of oral dryness and loss of appetite by a questionnaire.

SUBJECTS AND METHODS

A cohort of 99 elderly, non-psychiatric patients hospitalized for medical reasons; collection of demographic and health data from medical files, collection of USFR and SSFR, measurements of body mass index (BMI), lean body mass, fat body mass, serum album in concentration; completion of a questionnaire related to symptoms of oral dryness and the patients' appreciation of their nutritional status.

MAIN OUTCOME MEASURES

SSFR and USFR.

RESULTS

Mean age of the 99 patients was 82.5 +/- 4.0 years. Anthropometric examinations indicated malnutrition of severe or intermediate degree in about 50% while 46% showed moderately and 40% severely reduced albumin. Loss of appetite was present in 54% and 51% complained of oral dryness; 17% had an USFR <0.1 ml/min and 26% a SSFR <0.5 ml/min. Significant associations were found between (i) reduced salivary flow rate, malnutrition and reduced serum albumin concentration, (ii) recent loss of appetite and low serum album in concentration and (iii)complaints of oral dryness and reduced salivary flow rates. There were also significant associations between complaints of oral dryness, loss of appetite and low BMI.

CONCLUSION

Reduced salivary secretion and complaints of oral dryness could be signs of poor nutritional or general health status of elderly patients. Reduced salivary secretion and feeling of oral dryness could have a negative effect on alimentation, appetite and oral comfort.

Oral health and history of respiratory tract infection in frail institutionalised elders

OBJECTIVES

The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects.

SETTING AND SUBJECTS

302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist.

OUTCOME MEASURES

The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders.

RESULTS

One third (33%) of the subjects had experienced at least one episode of RTI, and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P = 0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1-3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5-6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated.

CONCLUSIONS

The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.

Caries prevalence and associated predisposing conditions in recently hospitalized elderly persons

The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender. Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.

Nutrition, general health status and oral health status in hospitalised elders

Biological malnutrition was assessed and correlated with salivary flow rates and oral health in 99 elderly, hospitalised non-psychiatric patients. The indicators of protein malnutrition used were arm circumference and serum albumin level and the indicators of energy malnutrition the body mass-index and the triceps skin-fold thickness. Unstimulated and stimulated salivary flow rates were measured according to Sreebny et al. Of the patients, 40% showed severely and 46% moderately reduced serum albumin levels and the anthropometric measurements indicated malnutrition in about 50%. Unstimulated hyposialia (< or = 0.1 ml/min) and stimulated hyposialia (< or = 0.5 ml/min) were observed in 17% and 26.5%, respectively. Significant associations (P < or = 0.05) were found between stimulated/unstimulated hyposialia and biological malnutrition. There was a negative relationship between the number of masticatory movements until swallowing a standard biscuit and skin fold thickness (P < or = 0.05). Current weight loss and biological malnutrition were related to poor appetite (P < or = 0.05). The study has confirmed poor general and oral health status as well as protein-energy malnutrition among elderly hospitalised patients. This situation was associated with loss of appetite, reduced salivary flow rates and a certain impairment of masticatory function which could jeopardise the reversibility of malnutrition and lead to increased morbidity and mortality.

Relationship between prosthodontic status, caries, and periodontal disease in a geriatric population

This study evaluated the influence of prosthodontic status on caries a and periodontal disease in a hospitalized population of elderly people. Among the data gathered was information on caries, gingival condition, oral hygiene, plaque accumulation, and factors related to the prevalence, type and quality of the prostheses present. There was no significant association between the type of rehabilitation and the economic, social, or educational variables, but it appeared that removable partial denture wearers had less concern for oral health. Root caries and periodontal diseases were more frequent when the restoration, either fixed or removable, was defective. Th results of this study indicate the importance of oral hygiene instruction and regular recalls among removable partial denture wearers.

Effect of controlled oral hygiene in overdenture wearers: a 3-year study

The effect of controlled oral hygiene was studied in 35 overdenture patients involving 80 abutments over a period of 3 years. Intensive instruction and motivation in oral hygiene care were carried out prior to prosthodontic treatment and two to four times yearly during the study period. The initial dental and periodontal conditions were very poor, with a mean loss of proximal bone adjacent to the abutments of 62% +/- 17%. During the study period, it was possible to maintain mean plaque index scores of 0.40 to 0.70 and mean gingival index scores of 0.90 to 0.98 adjacent to the abutments. There was spontaneous regression of 4- to 5-mm periodontal pockets, whereas deeper pockets persisted. There was no relationship between the patients' initial plaque index score and the oral and denture hygiene observed during the study. The results of the study showed that it was possible to maintain teeth as overdenture abutments in elderly patients initially having a poor dental and periodontal status.

Active and inactive root surface caries lesions in a selected group of 60- to 80-year-old Danes

In 90, 60- to 80-year-old patients with teeth retained in both jaws (mean 20.4 +/- 4.3), a total of 1,092 root surface lesions were recorded. Of these 156 were diagnosed as active caries lesions, whereas 509 were considered inactive, and 427 were filled. About 60% of the elderly had one or more active lesions and 79% had fillings. Seventy percent had more than 8 filled or carious (active or inactive) surfaces. The percentage of carious and filled root surfaces in relation to surfaces at risk demonstrated that the buccal surfaces of lower molars and premolars and upper canines were the most severely affected (RCI = 70%) with fillings predominating on easily accessible surfaces. A constant relationship between active and inactive lesions was found on all other surfaces but third molars and upper incisors. The data suggest that active and inactive root caries lesions must be diagnosed as separate entities if the dynamic nature of root surface caries is to be explored in epidemiological studies and clinical trials.

A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population

Prosthesis function and dental conditions were observed for 5 years in 27 elderly patients treated with mandibular cantilevered fixed partial dentures (FPDs) and in 26 elderly patients treated with distal-extension removal partial dentures (RPDs). All patients were treated with a complete upper denture. The patients were assigned randomly into two treatment groups that had the same composition with regard to sex, age, and distribution of teeth. The patients were under supervised oral hygiene and prosthodontic care. Clinical examination of prostheses, masticatory system, periodontal status, and caries was carried out yearly. Oral hygiene was good, and the periodontal status was maintained in both groups. Caries was observed six times more frequently in the RPD group than in the group with fixed restorations, however. Occlusal and functional conditions deteriorated in the RPD group only. Eight of 42 fixed partial dentures (19%) failed; of these, six were recemented with composite resin. Generally the need for dental and prosthetic follow-up treatment was more pronounced in the RPD group than in the FPD group.

Periodontal conditions following treatment with distally extending cantilever bridges or removable partial dentures in elderly patients. A 5-year study

The aim of the present study was to evaluate the periodontal conditions following treatment with distally extending cantilever bridges or removable partial dentures (RPDs) in elderly patients. All participants had a complete denture in the maxilla and moderate-to-advanced bone loss around the teeth present in the mandible. After undergoing periodontal treatment, 27 patients were treated with distally extending cantilever bridges and 25 patients with a RPD. During the first 2 years following prosthetic treatment, the patients were recalled twice a year and during the last 3 years once a year for oral prophylaxis and assessment of the periodontal status. The patients treated with a RPD showed higher mean Plaque and Gingival Indexes than the patients treated with cantilever bridges. No change in probing pocket depths was observed in either group, and only a small decrease in radiographic alveolar bone height was revealed. In conclusion, only minor changes in the periodontal conditions were recorded during the 5 years of observation after treatment with cantilever bridges or RPDs.

Corrosion properties of soldered joints. Part I: Electrochemical action of dental solder and dental nickel-chromium alloy

The corrosion properties of contact between six Ni-Cr alloys and two dental solders were evaluated. Ni-Cr alloys with low Cr content coupled with silver solder induced continuous galvanic current, whereas Ni-Cr alloys with high Cr and some Mo content coupled with silver or gold solder induced galvanic current for a short time. Six Ni-Cr alloys were divided into two groups according to the dissolution of Ni, one with low resistance and the other with high resistance. The initial equilibrium was induced between high resistance Ni-Cr alloys and both solders by less current density, which implies a smaller degree of corrosive current than that in low-resistance alloys. Corrosion was observed in the silver solder coupled with high-resistance Ni-Cr alloy, but was not found in the gold solder coupled with both alloys. In soldering Ni-Cr alloy, it is better to use a gold solder and a high-resistance Ni-Cr alloy for corrosion resistance.

[Few aspects with regard to diagnosis and treatment of oral candidiasis]

The present article discusses the rationale for daily use of the combination of amphotericin B (4 lozenges) intraorally and chlorhexidine denture disinfection (15 min) extraorally vs separate use of polyene antimycotics or chlorhexidine in the treatment of infectious denture stomatitis, frequently considered as the most common form of oral candidiasis. The amphotericin B/chlorhexidine combination has been standard treatment of infectious denture stomatitis in Scandinavia for more than 15 years. It was found to be the best among several regimens tested in 100 patients after a series of subjective and objective parameters had been used to record treatment efficacy in controlled clinical and microbiological studies. The fact that there was a significant (5% level) higher reduction of yeasts cultured from the palatal mucosa with this drug regimen than with the other modalities tested, including chlorhexidine lozenges/chlorhexidine denture disinfection, suggested that no drug interaction of clinical importance took place in vivo with this combination. Therefore, care should be taken when extrapolating findings on drug interaction in vitro (12) to the in vivo situation, and guidelines for treatment of oral candidiasis should preferably be based on controlled clinical and microbiological trials with patients. In order to prevent relapse of oral candidiasis after treatment, local and general predisposing factors should be eliminated, in particular reestablishment of plaque on the fitting side of the denture should be prevented.

Fluconazole in the treatment of Candida-associated denture stomatitis

A double-blind trial was carried out to study the effect of oral administration of fluconazole in the treatment of Candida-associated denture stomatitis. The study group consisted of 38 denture stomatitis patients who harbored yeasts, predominantly Candida spp., in significant numbers as determined by culture from the lesions. Half of the patients received 50 mg of fluconazole per day orally for 14 days, and the other half received placebo capsules. The following parameters were studied: degree of palatal erythema, presence of yeast cells (by plate count and microscopy of smears), identification to the species level of dominant yeast organisms, biotyping of Candida albicans, and treatment-related side effects. A significant reduction of erythema was seen after treatment with fluconazole, but the inflammation showed partial relapse 2 to 4 weeks after treatment was terminated. Reduced soreness of the oral mucosa was reported by six of the patients in the fluconazole group. No significant clinical or yeast flora changes were observed in the placebo group. Extensive changes in the yeast flora were observed in the fluconazole group, both in quantity and in composition of yeast species and C. albicans strains (biotypes), which perhaps indicated differences in pathogenicity and fluconazole susceptibility among various yeast species and C. albicans strains. Fluconazole did not produce any changes in the results of blood and urine analyses. The results indicate that fluconazole is a safe and well-tolerated antimycotic drug. The transient clinical and antimycotic effect may have been due in part to the possibility that therapeutic concentrations of the drug were not reached beneath the fitting denture surface and within the denture plaque.

The effect of controlled oral hygiene in overdenture wearers

The effect of controlled oral hygiene was studied in 40 patients treated with immediate complete overdentures in one or both jaws. Before prosthetic treatment conservative periodontal treatment was conducted with intensive instruction and motivation in oral hygiene care. Caries and periodontal status were recorded before and 2-4 weeks (day 0), 6 months, and 12 months after prosthetic treatment. However, the patients were seen more frequently for motivation and professional tooth cleaning. The material included 44 overdentures with a total of 92 abutments, with 1-4 abutments in each jaw. Before treatment the overall mean plaque index score was 1.43 +/- 0.68 and the overall mean gingival index score 1.57 +/- 0.53, and on day 0 and after 6 and 12 months the overall mean PlI score was 0.33-0.65 and the overall mean GI score 0.67-0.97. Adjacent to the abutments there was a significant reduction of the PlI and the GI scores from before treatment to day 0 and from day 0 to 6 months after prosthetic treatment (P less than 0.001). There was a significant reduction of pocket depth from day 0 to 6 months and from 6 to 12 months (P less than 0.01). The results of this study have shown that it is possible to maintain teeth as abutments for overdentures in patients with an initial poor dental status.