Chapter 12: Nutrient Deficiencies and Oral Health.

Malnutrition can significantly affect oral health, and poor oral health in turn can result in malnutrition. This co-dependent relationship, therefore, relies on good nutritional health promoting good oral health and vice versa. A diet lacking nutrients can lead to disease progression of the oral cavity through altered tissue homeostasis, reduced resistance to microbial biofilm, and a decrease in tissue healing.

Oral care after stroke: Where are we now?

Purpose: There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice.

Methods: A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.

'I didn't want to pass that on to my child, being afraid to go to the dentist': making sense of oral health through narratives of connectedness over the life course.

While previous sociological research on oral health has identified the relevance of personal relationships, there is more scope to analyse the mouth through a lens of connectedness. Recent qualitative interviews with 43 older people (65+) in England and Scotland found that participants constructed relational narratives to make sense of their oral health practices. By drawing on ideas of family practices, family display and personal life, we illustrate how the mouth can be understood relationally.

Quality of life and mastication in denture wearers and cleft lip and palate adults.

The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment.

Oral care as a life course project: A qualitative grounded theory study.

Objective: To report on a theory to explain the oral health of older people over the life course.

Background: The study of ageing has burgeoned into a complex interdisciplinary field of research, yet there are few studies in oral health from the perspective of older people that bridge the gap between sociology and oral health related research.

Methods: A grounded theory study involving a convenience sample of 15 men and 28 women aged between 65 and 91 years across different levels of education.

New frontiers in Dental Technology: An Overview.

The pace of technological advance across science is staggeringly fast. Our ability to translate some of the potential developments in technology into concepts/products/devices that can assist dentists in caring for patients is key to ensuring that both the profession and the people we care for derive full benefit from these new technologies. This overview will focus in four areas: research and how we gather and interpret data to inform health care; the diagnosis and prevention of disease; planning care; and new concepts in terms of achieving desired health outcomes for patients.

Oral hygiene of hospitalised older patients with lower limb fracture.

Introduction: good oral hygiene is important for eating, talking and improved quality of life, and is part of basic patient care, but there are few observational studies in hospitalised older patients. The aim of this study is to investigate dental plaque load in older patients over time in hospital.

Methods: we examined the mouths of 93 patients with lower limb fracture prospectively at day 1, 7 and 14 after admission in a Newcastle upon Tyne Hospital.

Development and feasibility testing of an oral hygiene intervention for stroke unit care.

Objective: To develop an oral hygiene complex intervention and evaluate its feasibility in a single UK stroke centre.

Background: Oral hygiene interventions might improve clinical outcomes after stroke but evidence-based practice is lacking.

Materials And Methods: We used a sequential mixed methods approach and developed an oral hygiene complex intervention comprising: (i) web-based education and 'hands-on' practical training for stroke unit nursing staff, (ii) a pragmatic oral hygiene protocol consisting of twice-daily powered (or manual if preferred) brushing with chlorhexidine gel (or non-foaming toothpaste) ± denture care.

Factors affecting patient valuations of caries prevention: Using and validating the willingness to pay method.

Objectives: Determining the value of, or strength of preference for health care interventions is useful for policy makers in planning health care services. Willingness to pay (WTP) is an established economic technique to determine the strength of preferences for interventions by eliciting monetary valuations from individuals in hypothetical situations. The objective of this study was to elicit WTP values for a dental preventive intervention and to analyze the factors affecting these as well as investigating the validity of the WTP method.

Dental and microbiological risk factors for hospital-acquired pneumonia in non-ventilated older patients.

Methods: We obtained a time series of tongue/throat swabs from 90 patients with lower limb fracture, aged 65-101 in a general hospital in the North East of England between April 2009-July 2010. We used novel real-time multiplex PCR assays to detect S. aureus, MRSA, E.

Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed-methods study.

Aims And Objectives: To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units.

Background: Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines.

The Seattle Care Pathway for securing oral health in older patients.

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force.

Developing pathways for oral care in elders: challenges in care for the dentate the subject?

Objective: This paper reviews potential age-associated risk factors for satisfactory oral function and oral disease to inform the development of care pathways for the older person.

Background: Alterations in dental status or both physical and biological change associated with age can impact on oral disease and oral function.

Materials And Methods: Older people tend to have fewer teeth and some are edentulous.

Use of micro-Raman spectroscopy to investigate hybrid layer quality in demineralized root dentine.

Treatment of early root caries using resin adhesives to stabilize demineralized dentine and deprive bacteria of nutrients is a recognized and conservative treatment option. Essential to its success is a stable resin-dentine interface, with effective infiltration of demineralized dentine and adequate resin curing. The objective of this study was therefore to examine degree of cure (DoC) and depth of penetration of dentine adhesives in demineralized dentine using micro-Raman spectroscopy.

Cantilever FPDs have lower success rates than end abutted FPDs after 10-years of follow-up.

Selection Criteria: Studies were located using a MEDLINE search strategy for English-language articles published from 1966 to 2004. A systematic review of 13 studies of cohort design (no randomized control trials were available) with the majority being retrospective. Seven hundred subjects with an age range of 26 to 84-years with a total of 816 FPDs with cantilever extensions were selected.

Patient satisfaction with two designs of implant supported removable overdentures; ball attachment and magnets.

Objective: The aim of this study was to compare ball and magnet attachments within implant-supported mandibular overdentures (ISMOD) using patient centred outcome measures. Our a priori hypothesis was that there is no difference in patient satisfaction between the two attachment types.

Material And Methods: In this within-subject crossover randomised clinical trial, edentulous patients were recruited to the study and completed a denture satisfaction questionnaire before having two implants placed in the intraforaminal region of the mandible.

Bonding of adhesive resin luting agents to metal and amalgam.

The shear bond strength of three adhesives, Panavia 21, Superbond, All Bond C&B Cement, and a dual cure resin (Variolink), to Ni-Cr-Be (Rexillium III), Midigold (Type III gold) and Amalgam (Sybraloy) were determined. Fifteen samples were prepared using 800 grit abrasive papers for Ni-Cr and Midi-Gold, and 100 grit papers for amalgam. Ni-Cr-Be and Midi-Gold samples were sandblasted for 30 s and steam cleaned for 10 s.

Bonding of crown and bridge adhesive resins to dentine.

The shear bond strength of three adhesives, Panavia 21, Superbond, All Bond C&B Cement, and Variolink (a dual cure resin) to various dentine depths were determined. Fifteen human fully erupted permanent first and second molars were wet ground using 500 and then 800 grit abrasive papers to expose the superficial, middle and the deep dentine, for each adhesive tested. Five samples were prepared for each dentine depth.

Researching the impact of oral health on diet and nutritional status: methodological issues.

Objectives: Assessment of the impact of dental function on diet and nutritional status requires robust methodologies and a standardised approach to increase accuracy of results and to facilitate cross study comparisons. The objectives of this paper are: to report the outcomes of a consensus workshop that critically reviewed publications reporting on dietary methodologies in relation to the impact of oral health on nutrition; to highlight future directions for research and; to make recommendations for appropriate use of methodologies for future research.

Data: Data relevant to nutrition and dental status published from 1980 to 2005 in English were presented at the consensus workshop for discussion and appraisal.

Association of salivary Streptococcus mutans levels determined by rapid detection system using monoclonal antibodies with prevalence of root surface caries.

Purpose: To examine the hypothesis that salivary Streptococcus mutans levels determined by a rapid detection system using monoclonal antibodies are associated with prevalence of root surface caries in a selected population of older adults.

Methods: Oral examinations were performed in 241 elderly people aged over 60 years with at least 10 teeth, and root surface caries were recorded. Populations of S.

Changes in oral health over a 10-yr period in Switzerland.

The Swiss Health Surveys are conducted every 5 yr, and alternate surveys contain information on oral health. Worldwide the population is ageing and oral health is improving. The aim of this study was to identify if these trends are continuing in a relatively affluent society with low levels of edentulousness.