In reply:

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65482/1/j.1532-5415.2002.50301.x.pd

Deep Fungal Infections in the Elderly

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111183/1/j.1532-5415.1988.tb04028.x.pd

Nosocomial Pneumonia and Oral Health

This article will critically review the evidence linking pneumonia to the aspiration of microbe-laden oropharyngeal secretions and tie that to the predisposition for these processes to affect dependent, medically compromised individuals. The goal of this review is to alert the reader to the role that oral disease and oral health play in fostering and preventing, respectively, widespread and potentially fatal pulmonary disease among high-risk individuals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73840/1/j.1754-4505.2005.tb01647.x.pd

The Relationship Between Dental Disease and Cerebral Vascular Accident in Elderly United States Veterans

We report here information obtained from a crossâ sectional study of 401 veterans, who were at least 60 years of age, which showed that several dental/oral conditions can be significantly associated with the diagnosis of a cerebral vascular accident (CVA), when included in a multivariate logistic regression model with and without many of the known risk factors for a CVA. The dental findings relative to the prevalence of dental caries and periodontal disease were not distinctly different between the subjects with and without a CVA in the bivariate analysis. A higher stimulated salivary flow was negatively associated with a CVA in the multivariate models. The plaque index and oral hygiene habits relating to brushing, flossing, and frequency of having teeth cleaned by a dentist/hygienist were significantly associated with a CVA in the bivariate analysis. Among these oral hygiene parameters, â needing help in brushing one’s teethâ and the reported annual visit to the dentist/hygienist for teeth cleaning remained significant in the multivariate models involving the dependentâ living subjects. The need for help in brushing one’s teeth could reflect the fact that many subjects had reduced manual dexterity as a result of the CVA and required this extra care. However, the finding that those dependentâ living individuals who reported that they did not have their teeth cleaned at least once a year were 4.76 times more likely to have had a CVA, suggests that a pattern of oral neglect might be associated with developing a CVA. The implications of this in terms of an intervention strategy for CVA warrants further consideration. However, caution is recommended because the data were obtained from a convenience sampling of older veterans and may not be generalizable to other populations. Ann Periodontol 1998;3:161â 174.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141992/1/aape0161.pd

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42426/1/455-13-2-69_13n2p69.pd

Oral Health is Cost-Effective to Maintain but Costly to Ignore

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66373/1/j.1532-5415.2002.50131.x.pd