The stomatognathic system in the elderly. Useful information for the medical practitioner

Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class). Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene) have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care

Translation and validation of an ageism scale for dental students in Switzerland

PURPOSE This study aimed to validate an ageism scale for dental students in Switzerland. METHODS The original scale was first translated to German and then evaluated by 14 experts for relevance; four items were eliminated. Validation of the resulting questionnaire was performed at three Swiss dental schools. Principal component analysis (PCA) was performed; Cronbach's alpha (α) was used to assess the internal consistency reliability, and Pearson's coefficient to identify any correlations with demographic parameters (P < 0.05). RESULTS PCA revealed 11 items among 4 factors (Overall: 11 items, α = 0.63, variance = 56.6%; Factor #1 (F1): items = 3, α = 0.64; Factor #2 (F2): items = 3, α = 0.42; Factor #3 (F3): items = 3, α = 0.35; Factor #4 (F4): items = 2, α = 0.37). F1 and F4 were correlated with clinical experience (F1: P = 0.042; F4: P = 0.006) and participation in a gerodontology course (F1: P = 0.021; F4: P = 0.004). F1 was correlated with experience of dealing with the elderly (P = 0.031), while residence locality was correlated with F3 (P = 0.047) and F4 (P = 0.043). F2 was correlated with the presence of elderly in the family (P = 0.047). CONCLUSION The translated dental ageism questionnaire for Switzerland resulted in an 11-item scale with acceptable reliability

An expert opinion from the European College of Gerodontology and the European Geriatric Medicine Society : European policy recommendations on oral health in older adults

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured

The effect of gender, age and rehabilitation with complete dentures on the human masseteric jaw-jerk reflex and the silent period: en EMG study

The aim of the present study was to investigate any variations in the masseteric jaw-jerk reflex and the silent period related to gender, age and rehabilitation with complete dentures. Surface electromyographic recordings were obtained after chin taps from the masseter muscle of the preferred chewing side, during mandibular rest and at moderate intercuspal clenching (40% of the individual maximum clenching masseteric RMS activity), using a computerized recording and analysis system. The reflexes were elicited in 22 younger dentate adults, 22 older dentate adults, 22 older experienced complete denture wearers and seven older subjects who had been fitted with new complete dentures one to three weeks previously. In the first three groups gender distribution was equal. The within and between-session reproducibility of the jaw- jerk at rest using the present methodology, was tested in five young females and found satisfactory. During intercuspal clenching, the occurrence of the jaw-jerk was reduced compared to the rest values in all groups except for the inexperienced denture wearers. This contrast was smaller in the experienced denture wearers. It was suggested that the simultaneous activation of the periodontal ligament receptors may occasionally inhibit the masseteric monosynaptic excitation. In the denture wearers a potential weaker inhibitory effect of the mucosal mechanoreceptors was speculated. Moreover when clenching, the amplitudes were higher and the latencies shorter (p0.05).The duration was however affected by the silent period type (p<0.05), thus by the measuring technique. In the female subjects in all groups, a systematic tendency was observed towards shorter latencies in the jaw-jerk and the early silent period, and towards increased amplitudes of the jaw-jerk, particularly at rest. Increased gender variation was observed in the denture wearers. However those differences were usually not statistically significant. The age-related variation in the jaw-jerk and the silent period was investigated in 22 younger and in 22 older dentate adults. In the older participants, the occurrence of the jaw-jerk was reduced, the latency of the jaw-jerk at rest and the latency of the early silent period were increased and the amplitude of the jaw-jerk at rest was diminished (p<0.05). The differences observed were related to the age changes in the various elements of the responsible reflex arcs, including the sense organs, the muscles, the peripheral nerves and the central nervous system. The effect of denture wearing on the jaw-jerk and the silent period was investigated in 22 older dentate subjects and in 22 older experienced denture wearers. Both reflexes were present in the denture wearers. In the denture subjects the occurrence of the jaw-jerk, the duration of the jaw-jerk at clench and the latencies of the early and late phases of depression were increased (p<0.05). The similarities in reflex activity between the dentate subjects and the denture wearers indicate that the periodontal ligament and the intradental receptors are not necessary for the elicitation of the reflexes studied. Increased variation was however observed in the seven subjects recently rehabilitated with complete dentures.Ο σκοπός της μελέτης ήταν η διερεύνηση της επίδρασης του φύλου, της ηλικίας και της χρήσης ολικών οδοντοστοιχιών στην αντανακλαστική δραστηριότητα του μασητήρα στον άνθρωπο και συγκεκριμένα: στο μυοτατικό αντανακλαστικό της γνάθου, β) στην ταχεία και παροδική δραστηριοποίηση προ της ΠΣ, που εκλύεται κατά τη διέγερση του αντίστοιχου νευρωνικού κυκλώματος σε θέση ισομετρικής συστολής των ανασπώντων σε μέγιστη συγγόμφωση και γ) στην περίοδο σιγής. Το δείγμα απετέλεσαν 22 νέοι ενόδοντες με μέση ηλικία τα 23.2 έτη, 22 ηλικιωμένοι ενόδοντες με μέση ηλικία τα 61.3 έτη και 22 ηλικιωμένοι νωδοί προσαρμοσμένοι ικανοποιητικά στις ολικές τους οδοντοστοιχίες με μέση ηλικία τα 63.1 έτη και 7 νωδοί ηλικιωμένοι οι οποίοι τοποθέτησαν ολικές οδοντοστοιχίες πριν από μία έως τρείς εβδομάδες. Η πρόκληση ων αντανακλαστικών έγινε με χτύπημα στο γένειο με νευρολογικό σφυρί και η καταγραφή της ηλεκτρομυογραφικής δραστηριότητας με ηλεκτρόδια επιφανείας μέσω συστήματος ηλεκτρονικής καταγραφής και ανάλυσης. Στις γυναίκες καταγράφηκε μία συστηματική τάση για μικρότερους λανθάνοντες χρόνους αντανακλαστικής δραστηριότητας και για μεγαλύτερο πλάτος του μυοτατικού αντανακλαστικού σε ανάπαυση. Οι διαφοροποιήσεις αυτές κατά κανόνα δεν έφταναν σε στατιστικά σημαντικά επίπεδα. Με την αύξηση της ηλικίας παρατηρήθηκε μείωση στη συχνότητα εμφάνισης του μυοτατικού αντανακλαστικού, αύξηση του λανθάνοντα χρόνου έκλυσης του μυοτατικού σε ανάπαυση και της περιόδου σιγής, ελάττωση του πλάτους του μυοτατικού αντανακλαστικού σε ανάπαυση και αύξηση της βιολογικής μεταβλητότητας. Στα άτομα με ολικές οδοντοστοιχίες στις οποίες είχαν καλά προσαρμοστεί δεν καταγράφηκαν συστηματικές διαφοροποιήσεις στην αντανακλαστική δραστηριότητα με βασική εξαίρεση την αυξημένη εμφάνιση του μυοτατικού αντανακλαστικού σε ανάπαυση και σε συστολή. Αυξημένη μεταβλητότητα καταγράφηκε ωστόσο στα άτομα τα οποία είχαν πρόσφατα τοποθετήσει οδοντοστοιχίες και δεν είχε ακόμα αναπτυχθεί ικανοποιητικός προσαρμοστικός μηχανισμός. Η παρουσία των περιοδοντικών υποδοχέων και των υποδοχέων των δοντιών δεν θεωρήθηκε απαραίτητη για την έκλυση της μελετώμενης αντανακλαστικής δραστηριότητας, ενώ πιθανολογείται η ανασταλτική τους επίδραση στους κινητικούς νευρώνες του μασητήρα. Η σταθερότητα της συχνότητας εμφάνισης της πρώιμης περιόδου σιγής ανεξαρτήτως βιολογικών συνθηκών απαιτεί την περαιτέρω διερεύνηση του πιθανού διαγνωστικού και προγνωστικού της ρόλου σε περιπτώσεις δυσλειτουργίας του στοματογναθικού συστήματος ή και σε άλλες παθήσεις

Sociomedical and oral factors affecting masticatory performance in an older population.

OBJECTIVES To assess the sociomedical and oral factors affecting masticatory performance in a community-dwelling older population. MATERIALS AND METHODS Community-dwelling persons over 60 years were investigated using medical and dental oral interviews, oral and denture examination (natural teeth, tooth mobility, number of occluding tooth pairs, and removable dentures' prevalence and quality), and evaluation of masticatory performance using a mixing ability test. RESULTS A total of 130 participants with a mean age of 73.9±8.5 years were recorded. Fifty-eight (44.6%) used various types of removable prostheses. Twenty were edentulous and used a pair of complete dentures. Univariate analyses revealed statistically significant associations (p≤0.05) between masticatory performance and aging, marital status, subjective chewing ability, use of removable dentures, use of various combinations of complete dentures, pain caused by maxillary denture, number of teeth, tooth mobility, posterior chewing pairs, all chewing contacts natural or prosthetic, retention of mandibular partial dentures, and dentures' occlusion. The multivariable quantile regression analysis revealed that fewer natural teeth (95% CI: -0.02-0.01, p<0.001), being edentulous and using a pair of complete dentures (95% CI: 0.09-0.35, p=0.001), and larger percentage of severely mobile teeth (95% CI: 0.07-0.82, p=0.020) were associated with lower masticatory performance. CONCLUSIONS Poor masticatory performance in older adults was associated with fewer teeth, being edentulous and using a pair of complete dentures, and increased prevalence of severe tooth mobility. CLINICAL RELEVANCE Retaining the natural dentition and preventing and treating periodontal disease are important measures to maintain masticatory performance in older adults

Oral factors and adherence to Mediterranean diet in an older Greek population.

PURPOSE The aim of this study was to investigate the effect of oral factors on adherence to the Mediterranean diet in an older population METHODS: 130 persons over 60 years visiting Open Care Community Centers for Older People participated in this study. Oral interviews recorded demographic and sociomedical information, subjective oral complaints, and dental habits. Adherence to Mediterranean diet was assessed using the MDI_BNC4H index (range: 0-14). An oral examination was performed, and evaluation of the masticatory performance was carried out using a two-color chewing gum that was digitally analysed. RESULTS The mean age of the study participants was 73.9 ± 8.5 years. The score of adherence to the Mediterranean diet ranged from 3 to 9 (5.6 ± 1.4). 58 participants used removable prostheses, while 20 used a pair of complete dentures. Univariate analyses revealed that the parameters that negatively significantly, or marginally significantly, affected the level of adherence to the Mediterranean diet were lower masticatory performance (p = 0.050), larger number of drugs per day (p = 0.056), higher BMI (p = 0.043) and smoking (p = 0.053). The multivariable analysis revealed that lower adherence to the Mediterranean diet was significantly associated with higher BMI (p = 0.047) and lower masticatory performance (p = 0.050). CONCLUSIONS Increased masticatory performance was an independent predictor of better adherence to the Mediterranean diet in an older population