Need of Assistance with Daily Oral Hygiene Measures Among Nursing Home Resident Elderly Versus the Actual Assistance Received from the Staff

The aim was to evaluate the need of assistance with daily oral hygiene measures among nursing home resident elderly versus the actual assistance received from the staff. The need of daily oral hygiene assistance was assessed descriptively for nursing home resident elderly who participated in an annual oral health screening in three geographical regions in Sweden, in the year 2008. All individuals of age ≥ 65 years were included (n = 22,453; 6,327 men; 16,126 women). The proportion of individuals in need of assistance with daily oral hygiene measures was 77.5 % (n=22,453), whereas the proportion of individuals receiving assistance with daily oral hygiene measures was 6.9 % in total (n=22,453). The proportions were largely similar in all geographical regions. There seems to be a large discrepancy between the need of assistance with daily oral hygiene measures, and the oral hygiene assistance received, among nursing home resident elderly

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Systematic review of measurement properties of methods for objectively assessing masticatory performance

The objectives of this study is to identify methods for objectively assessing masticatory performance (MP) and to evaluate their measurement properties. A secondary objective was to identify any reported adverse events associated with the methods to assess MP. Bibliographic databases were searched, including MEDLINE, Embase, Web of Science Core Collection, Cochrane, and Cinahl databases. Eligible papers that satisfied predefined inclusion and exclusion criteria were appraised independently by two investigators. Four other investigators independently appraised any measurement properties of the assessment method according to the consensus‐based standards for the selection of health measurement instruments checklist. The qualities of the measurement properties were evaluated using predefined criteria. The level of evidence was rated by using data synthesis for each MP assessment method, where the rating was a product of methodological quality and measurement properties quality. All studies were quality assessed separately, initially, and subsequently for each method. Studies that described the use of identical assessment method received an individual score, and the pooled sum score resulted in an overall evidence synthesis. The level of evidence was synthesized across studies with an overall conclusion, that is, unknown, conflicting, limited, moderate, or strong evidence. Forty‐six out of 9,908 articles were appraised, and the assessment methods were categorized as comminution (n = 21), mixing ability (n = 23), or other methods (n = 2). Different measurement properties were identified, in decreasing order construct validity (n = 30), reliability (n = 22), measurement error (n = 9), criterion validity (n = 6), and responsiveness (n = 4). No adverse events associated with any assessment methods were reported. In a clinical setting or as a diagnostic method, there are no gold standard methods for assessing MP with a strong level of evidence for all measurement properties. All available assessment methods with variable level of evidence require lab‐intensive equipment, such as sieves or digital image software. Clinical trials with sufficient sample size, to infer trueness and precision, are needed for evaluating diagnostic values of available methods for assessing masticatory performance

Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults : A randomised clinical trial

Objective: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. Method: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. Results: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. Conclusion: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.