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PURPOSE: The purpose of this animal study was to confirm that laser Doppler flowmetry (LDF) is a reproducible method for the assessment of maxillary and mandibular alveolar bone vascularity and that there is less vascularity in irradiated mandibular and maxillary bone compared to nonirradiated bone. MATERIALS AND METHODS: All maxillary and mandibular premolars and molars of 6 Göttingen minipigs were extracted. After a 3-month healing period, 3 minipigs received irradiation at a total dose of 24 Gy. Three months after irradiation, 5 holes were drilled in the residual alveolar ridge of each edentulous site in each minipig. Local microvascular blood flow around all 120 holes was recorded by LDF prior to implant placement. In 1 irradiated and 1 nonirradiated minipig, an additional hole was drilled in a right maxillary site to enable repeated LDF recordings. RESULTS: The alveolar bone appeared less vascularized in irradiated than in nonirradiated minipigs. The effect of radiation appeared more pronounced in the mandible than in the maxilla. LDF was demonstrated to be a reproducible method for assessing alveolar bone vascularity. However, recordings varied by edentulous site as well as by minipig. CONCLUSION: The authors' hypotheses regarding LDF and vascularity were supported. Further research validating the use of LDF in human beings, especially in those who have undergone radiation therapy for head and neck cancer, is necessary. [ABSTRACT FROM AUTHOR]

As part of a systematic literature review, a comprehensive literature search was carried out to identify risk factors for aspiration pneumonia in frail older people. A prominent risk factor found was dysphagia with evidence level 2a, according to the Oxford Centre for Evidence-based Medicine Levels of Evidence. Subsequently, a meta-analysis of 4 cohort, 1 case-cohort, and 1 case-control study on dysphagia as a risk factor of aspiration pneumonia in frail older people was performed. Using a random effects model, we found a positive correlation between dysphagia and aspiration pneumonia: OR = 9.84; 95%CI = 4.15 - 23.33 (test for statistical homogeneity: p < 0.001). Then, a subgroup meta-analysis was performed with 4 cohort studies, all including patients with a cerebrovascular disease. Once again, a positive correlation was found between dysphagia and aspiration pneumonia: OR = 12.93; 95%CI = 8.61 - 19.44. The test for statistical homogeneity revealed no statistically significant result (p = 0.15). It was concluded that dysphagia is a serious risk factor for aspiration pneumonia in frail older people, particularly in those suffering from a cerebrovascular disease. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: The aim of this study was to determine the validity and properties of the Summated Xerostomia Inventory-Dutch Version in samples from Australia, The Netherlands, Japan, and New Zealand. STUDY DESIGN: Six cross-sectional samples of older people from The Netherlands (n = 50), Australia (n = 637; n = 245), Japan (n = 401), and New Zealand (n = 167; n = 86) were enrolled. Data were analyzed by using the Summated Xerostomia Inventory-Dutch Version. RESULTS: All datasets revealed a single extracted factor which explained about one-half of the variance, with Cronbach alpha values >=0.70. When mean scale scores were plotted against a 'gold-standard' xerostomia question, statistically significant gradients were observed, with the highest score seen in those who always had dry mouth, and the lowest in those who never had it. CONCLUSIONS: The Summated Xerostomia Inventory-Dutch Version is valid for measuring xerostomia symptoms in clinical and epidemiologic research. [ABSTRACT FROM AUTHOR]

Implant-supported dentures seem particularly appropriate for the predicament of being elderly and becoming edentulous. The aim of this article was to review the literature on success of dental implants in elderly people. The results of two studies suggested that the treatment with implants can be considered safe and predictable for older as well as for younger patients. Three studies found no increased implant failure-rate in patients with a compromised medical status. Four studies revealed high success-rates of dental implants among groups of elderly people. Within the limitations of this review of the literature it can be concluded that old age does not seem to represent a factor of major prognostic significance in treatment with dental implants. [ABSTRACT FROM AUTHOR]

If quality of care for elderly patients is to be achieved, thorough and realistic geroprosthodontic treatment planning is essential. This requires mature consideration, incorporating comprehensive patient assessment and selection of the most appropriate treatment option for each patient. The latter should be based on criteria which meet the demands of a healthy dentition and which enable a patient to achieve satisfactory oral function. The Nijmegen and Manchester Dental Schools have evolved simple patient-related treatment guidelines. These start with a problem-oriented approach which leads to a provisional treatment. The provisional treatment is intended to result in a healthy dentition that is monitored over an appropriate period. Evaluation of the provisional treatment leads to three options: extension of the monitoring time, preservation of the natural occlusion or loss of the natural occlusion. Definitive prosthodontic treatment plans are based on the second or third option. In the maintenance of good oral health after prosthodontic treatments, plaque and diet control are essential elements. Recall or maintenance programmes must be carried out if successful treatment is to be achieved and maintained. [ABSTRACT FROM AUTHOR]

Comprehensive oral health care is an essential feature of quality of life. In the near future, a greater number of elderly people will retain more natural teeth, whether or not supplemented by prosthetic provisions, and/or may be provided with implants. As a consequence, oral self-care will be much more demanding. Prevention must reduce the greater risk of oral disease for elderly people. Effective early intervention strategies are: promotion of over-all general health, obviation of stereotypes, education by dental hygienists, instruction and demonstration combined with systematic evaluation, use of a fluoride containing dentifrice, and regular professional support and use of chlorhexidine rinses for less well and confused elderly. [ABSTRACT FROM AUTHOR]

Patients with complaints of halitosis do seek treatment from physicians and dental practitioners, because of the fear that their halitosis may interfere with their social activities. Although the prevalence of halitosis has been reported to be as high as 50%, most physicians and dental practitioners are poorly informed about the causes and treatments of halitosis. In order to care for patients with complaints of halitosis a multidisciplinary team was established at the Erasmus Medical Centre, Rotterdam, The Netherlands. The team included a dental hygienist, an otorhinolaryngologist, and a dentist, who developed a special halitosis programme. One short press release regarding the establishment of the team, was provided to the national press-centre. In the out-patient clinic more than 700 patients were seen by the team. Using a structured questionnaire fed to a PC, patients answered questions regarding complaints about the oral cavity, the upper respiratory tract, the throat, their general health, their cleansing habits of the oral cavity, and prior experiences with general physicians, dental practitioners, and medical specialists. They underwent examinations of the extent of their halitosis, of the perioral and neck region, the oral cavity, the upper respiratory tract, and the upper digestive tract. Finally, the members of the team came to a joint diagnosis and a joint treatment plan for every individual patient. Of the first 700 consecutive patients around 90% had a natural dentition without removable partial dentures. More than 60% were diagnosed as having periodontal disease with pockets of 4 mm or more in the maxilla. This figure was more than 50% in the mandible. Around 95% had tongue coating. [ABSTRACT FROM AUTHOR]

Abstract Background The increase of the proportion of elderly people has implications for health care services. Advances in oral health care and treatment have resulted in a reduced number of edentulous individuals. An increasing number of dentate elderly people have tooth wear, periodontal disease, oral implants, and sophisticated restorations and prostheses. Hence, they are in need of both preventive and curative oral health care continuously. Weakened oral health due to neglect of self care and professional care and due to reduced oral health care utilization is already present when elderly people are still community-dwelling. At the moment of (residential) care home admittance, many elderly people are in need of oral health care urgently. The key factor in realizing and maintaining good oral health is daily oral hygiene care. For proper daily oral hygiene care, many residents are dependent on nurses and nurse aides. In 2007, the Dutch guideline "Oral health care in (residential) care homes for elderly people" was developed. Previous implementation research studies have revealed that implementation of a guideline is very complicated. The overall aim of this study is to compare a supervised versus a non-supervised implementation of the guideline in The Netherlands and Flanders (Belgium). Methods/Design The study is a cluster randomized intervention trial with an institution as unit of randomization. A random sample of 12 (residential) care homes accommodating somatic as well as psycho-geriatric residents in The Netherlands as well as in Flanders (Belgium) are randomly allocated to an intervention or control group. Representative samples of 30 residents in each of the 24 (residential) care homes are monitored during a 6-months period. The intervention consists of supervised implementation of the guideline and a daily oral health care protocol. Primary outcome variable is the oral hygiene level of the participating residents. To determine the stimulating or inhibiting factors of the implementation project and the nurses' and nurse aides' compliance and perceived barriers, a process evaluation is carried out. Discussion The method of cluster randomization may result in a random effect and cluster selection bias, which has to be taken into account when analyzing and interpreting the results. Trial registration Current Controlled Trials ISRCTN86156614