Detailed Dental Examination Research Articles

Vitamin D, periodontitis and tooth loss in older Irish adults.

The aim of this study is to investigate whether 25-hydroxyvitamin D (25(OH)D) is associated with periodontitis and tooth loss in older adults. A total of 2346 adults underwent a detailed dental examination as part of the health assessment of a national population study - The Irish Longitudinal Study of Ageing. 25(OH)D analysis was performed on frozen non-fasting total plasma using LC-MS. The analysis included both multiple logistic regression and multinominal logistic regression to investigate associations between 25(OH)D concentration, periodontitis and tooth loss, adjusting for a range of potential confounders. Results of the analysis found the mean age of participants was 65·3 years (sd 8·2) and 55·3 % of the group were female. Based on the quintile of 25(OH)D concentration, participants in the lowest v. highest quintile had an OR of 1·57 (95 % CI 1·16, 2·13; P < 0·01) of having periodontitis in the fully adjusted model. For tooth loss, participants in the lowest v. highest quintile of 25(OH)D had a RRR of 1·55 (95 % CI 1·12, 2·13; P < 0·01) to have 1-19 teeth and a RRR of 1·96 (95 % CI 1·20, 3·21; P < 0·01) to be edentulous, relative to those with ≥ 20 teeth in the fully adjusted models. These findings demonstrate that in this cross-sectional study of older men and women from Ireland, 25(OH)D concentration was associated with both periodontitis and tooth loss, independent of other risk factors.

The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries.

To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries. We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables. For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth. Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.

A suggested universal protocol for dental examination in sports.

The athletes of any sport and level submit their bodies to constant exercise. Any given pathology can increase the risk of injury, illness, or even reduced performance. The medical examination is valuable in diagnosing existing health problems and preventing medical issues that might compromise the athlete's overall health when exercising. The stomatognathic system is not an exemption, as oral pathologies, including dental caries and periodontal diseases, are found in high incidence in sports. The need for accurate and detailed dental examination in sports leaded dentists from the European Association for Sports Dentistry and the Academy for Sports Dentistry to elaborate a universal dental examination in sports protocol that can record the overall oral health of the athlete, including the teeth, periodontium, and musculoskeletal screening, for all athletes. The outcome of this stomatognathic examination allows sports physicians and professionals other than dentists to have a complete image of the individual oral health condition of any given athlete, and it allows the dentists to efficiently screen and prevent pathologies, as well as to advise on the eligibility to practice sports from the oral health perspective.

Studies on the psychodynamics of Chronic Orofacial Pain Disorder

Studies on the psychodynamics of Chronic Orofacial Pain Disorder Objectives: Psychodynamic factors play an important role in its emergence and development of Chronic Orofacial Pain Disorder (COP), which is also known as Chronic Primary Orofacial Pain. This factors form the basis for differentiated psychotherapy. Methods: Seven female and two male patients with COP who had visited the Dental School, University Hospital, Ludwig Maximilian University of Munich, and the dental surgery of a practising dentist over the year were included in the study. Following a detailed dental examination, a psychodynamic interview was videotaped, reconstructing the connections between the life history and the development of the illness. Psychosomatic data were assessed by 3 psychotherapists based on a consensus model with regard to symptom trigger mechanisms such as conflicts and pressure, the development of symptoms, and the personality structure. Pathogenetically, we differentiated among conversion, somatization and projection. Results: The patients had a mean age of 57 years (range: 44-67) and an average illness duration of three (1-5) years. The average age where the illness had manifested was 54 (43-64). All patients showed clear psychodynamic factors in the development and course of the illness. The symptoms developed mainly during transitional situations during the life history, predominately in midlife. During this phase, dental treatment undertaken for whatever reason could trigger the chronic symptoms, which could then be further exacerbated by further dental interventions. The mode of symptom development by equal number of patients related to a somatoform disorder, such as a somatization of affect, a conversion with conflict symbolism and a projective-hypochondriac disorder. In the remaining patients, COP was an accompanying symptom of depressive disorder or the consequence of a posttraumatic stress disorder with self-mutilating tendencies. Conclusion: The consideration of psychosomatic connections and pathogenetic differentiation is helpful for the understanding and management of COP. This diagnostic differentiation could serve as a basis for prognosis and for specific therapeutic indications. Despite numerous general researches about chronic pain syndromes, there is a lack of intervention studies which take into account the specific conditions of COP on a larger sample.

Oral Mucositis Association with Periodontal Status: A Retrospective Analysis of 496 Patients Undergoing Hematopoietic Stem Cell Transplantation

Background: Hematopoietic stem cell transplantation (HSCT) can induce serious oral complications, including oral mucositis (OM). The presence of periodontal inflammation before HSCT is believed to be associated with OM. The aim of our study was to determine the prevalence and severity of OM in patients undergoing HSCT and its relation to periodontal status. Patients and methods: This is a retrospective study of patients who underwent HSCT and a detailed dental examination between 2007 and 2015. The dental and periodontal status of all patients was evaluated by clinical and radiographic examination prior to HSCT. Oral health was assessed with the gingival index, the the community periodontal index, presence of plaque-related gingivitis, and marginal periodontitis. During the HSCT period, patients were examined daily for the presence of OM, which was graded according to World Health Organization (WHO) classification if present. The patients were assigned to the groups according to type of transplantation: autologous HSCT, myeloablative allogeneic HSCT, and non-myeloablative allogeneic HSCT. Results: A total of 496 patients were included in the study. OM was present in 314 of 496 patients (63.3%): 184/251 (73.3%) in the autologous group, 100/151 (66.2%) in the myeloablative allogeneic group, and 30/94 (31.9%) in the nonmyeloablative allogeneic group. Significantly more patients suffered from OM in the autologous and myeloablative groups versus the nonmyeloablative conditioning group (p < 0.001). The presence of periodontal inflammation did not significantly differ among the groups. There was only a borderline trend for the higher prevalence of OM in the non-myeloablative allogeneic nonmyeloablative group when periodontal inflammation was present (0.073939). Conclusions: Oral mucositis prevalence and severity after stem cell transplantation is not widely affected by the oral hygiene and periodontal disease presence before HSCT. We confirmed the wide-known connection of the conditioning regimen intensity to the prevalence of OM.

Temporomandibular disorder as risk factor for radiation-induced trismus in patients with head and neck cancer.

ObjectivesThe aim of this study was to investigate if patients with temporomandibular disorders (TMD) prior to head and neck cancer (HNC) treatment are at higher risk of developing trismus after oncological treatment.Materials and MethodsEighty‐three study patients underwent detailed dental examination prior oncological treatment and 6 months after radiotherapy completion, including evaluation of temporomandibular jaw function, palpation of the jaw muscles, and measurement of mouth opening capacity. TMD criteria were based on both clinical examination findings and patient‐reported symptoms. TMD at baseline was used in regression analysis in order to predict restricted mouth opening.ResultsAt the 6 months follow‐up more than a third of the patients (35%) were examined with reduced mouth opening of >20% compared to baseline. A majority of the patients had bilateral tenderness of both the temporal and the masseter muscle. At the 6 months follow‐up, 42% of the study patients reported mouth opening problems. About one‐third of the patients suffered from fatigue and stiffness of the jaw as well as pain when mowing the jaw. Two questions from the validated symptom‐specific Gothenburg Trismus Questionnaire were found to be related to a statistically significant increased risk of restricted mouth opening after radiotherapy; “During the last week, have you felt: Pain on moving the jaw?” (OR [95% CI] 5.9 (1.2–29.4) [p = 0.030]) and “During the last week, have you felt pain and tenderness in the muscles of mastication?” (OR [95% CI] 5.90 [1.19–29.40] [p = 0.030]).ConclusionsTMD is common amongst HNC patients. Patients who suffer from pain in the jaw muscles and pain when moving the jaw before start of treatment are at higher risk of radiation‐induced trismus after 6 months. Clinicians should strive for optimizing the patients pain treatment and oral health before, during, and after radiotherapy.

Interdisciplinary approach to the management of a patient with Sjogren’s syndrome: a clinical case

Dryness of the mucous membranes (in mouth, nose, genitals in women) and skin are the most common complaints of patients with Sjogren’s disease — a multisystem immune‑mediated disorder that causes anxiety and concern associated with the difficulties of initial diagnosis. The authors present a clinical case of a patient with primary Sjogren’s syndrome, a large number of symptoms of digestive diseases, complaints of dryness of mucous membranes, in particular the oral cavity. The diagnosis was confirmed by allied specialists such as ophthalmologist, gynecologist, rheumatologist, dentist. Detailed dental examination revealed the main dental complaints (constant dry mouth, galitos, changes in taste), clinical condition (dryness of the red border of the lips, swelling of the oral mucosa, changes in the relief of the gums), decreased secretory activity and significant reduction of unstimulated salivation with a moderate level of stimulated salivation. It is noted that a significant decrease in sialometry (0.01 ml per minute) and functional activity of the small salivary glands (up to 18) confirms the presence of true xerostomia. Micro‑crystallization of saliva revealed disorganization of irregularly shaped structures, as well as a significant number of organic inclusions, which indicates a violation of homeostasis in the oral cavity. Given the results of ultrasound examination of the large salivary glands and the absence of enlargement and swelling of the glands during clinical examination, we can assume that the destructive damage to the glands is not so pronounced, evacuation function of the gland is not reduced, but the amount of secretion is significantly reduced. To provide medical aid to patients with Sjogren’s syndrome, the accessibility of the qualified consultation is important and required, with conduction of comprehensive examinations by allied specialists, including a dentist.&#x0D;

Systemic inflammation and the relationship between periodontitis, edentulism, and all-cause mortality: A 17-year prospective cohort study.

The aim was to investigate the role of systemic inflammation in the relationship between periodontitis, edentulism, and all-cause mortality in a group of men in Northern Ireland aged 58-72 years. A representative sample of 1558 men had a detailed dental examination between 2001 and 2003. The primary end point was death from any cause. Cox's proportional hazards model was used to assess the longitudinal relationship between periodontitis, edentulism, and all-cause mortality. Accelerated failure time modelling was performed to investigate the mediating role of systemic inflammation. Mean age of the men at baseline was 64.3 (standard deviation 2.9) years. During a median follow-up of 17 years, 500 (32.1%) men died. After adjustment for confounding variables, compared to men with no/mild periodontitis, edentulous men had a hazard ratio for all-cause mortality of 1.52 (95% confidence interval [CI] 1.16-1.99) p < .01 and for those with severe periodontitis, it was 1.34 (95% CI 1.06-1.70) p=.01. Systemic inflammation accounted only for a minor mediating pathway effect of 10%. There was evidence in this group of men that those who were edentulous or had severe periodontitis had a significantly increased risk of all-cause mortality. Systemic inflammation was not a major explanatory mediator of this association.

Odontogenic cutaneous sinus tract - misdiagnosis and follow-up in a seven-year-old boy

Cutaneous sinus tracts of dental origin are relatively rare, but frequently misdiagnosed. In this case report, we present a seven-year-old patient with a cutaneous lesion in the left submandibular region misdiagnosed by a physician as an abscess secondary to suppurative lymphadenitis, and thus incorrectly treated with surgery and systemic antibiotics. Following a detailed dental examination, the patient was correctly diagnosed with an odontogenic sinus tract from a periapical abscess of tooth 36. Treatment of the immature tooth was initiated with apexification combined with nonsurgical endodontic treatment. The cutaneous and the periapical lesions were all resolved after the treatment and there has been no recurrence during an eight-year follow-up.

Frequency of Molar Incisor Hypomineraliazation and Associated Risk Factors - A Study from Southern Punjab, Pakistan

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; The prevalence of molar incisor hypomineralization varies in different regions of the world. This disorder leads to susceptibility to development of complications and hence timely management is mandatory. This study was designed to determine the frequency of molar incisor hypomineralization in children presenting to dental out-patient department of a tertiary care hospital in Pakistan.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a cross sectional descriptive study carried out at Ibn- Sina Hospital Multan, Pakistan. A total of 300 subjects including children and adolescents presenting to the outdoors were included. The detailed dental examination was carried out by two expert dentists for diagnosis of molar incisor hypomineralization. Data regarding risk factors was collected by administering a standardized and validated questionnaire to the parents about prenatal and post-natal risk factors.&lt;br /&gt;&lt;strong&gt;Results&lt;/strong&gt;: A total of 3.33% children were diagnosed with molar incisor hypomineralization. Male to female ratio was 1:1.3. There was no significant difference with respect to gender. The mean teeth affected per child were 2.1 &amp;plusmn; 07. Risk factors found in the study population were asthma, history of typhoid and measles, and frequent antibiotic use.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Molar incisor hypomineralization is quite less frequent in general population with no gender predominance. Pre and post-natal factors effect its development that requires timely management strategies by dental specialists.&lt;/p&gt;

Dental assessment of odontogenic maxillary sinusitis, aided by Cone Beam Computed Tomography.

To identify tooth diseases as potential causative factors in the development of maxillary sinus lesions, with the aid of clinical examination combined with Cone Beam Computed Tomography (CBCT), in the patients with persistent sinus-like ailments, unresponsive to routine treatment offered by otolaryngologists. In 44 patients with suspected odontogenic maxillary sinusitis, a dental examination with tooth vitality test was carried out, in conjunction with CBCT. The study involved 29 women and 15 men (age range 19-69 years, mean age 43 (SD = 13.9) years). In 15 (34.1%) patients the odontogenic lesions were encountered in maxillary sinuses. A total of 33 causative teeth were identified, of which 13 (39%) were after root canal treatment (RCT). Only one of the teeth had a properly reconstructed crown, and only one tooth had the root canals properly filled-in. Most frequently, the lesions in the sinuses were attributed to the inflammation of periapical tissues; the first molar having been established as the most common causative tooth. A detailed dental examination, pursued in conjunction with CBCT analysis, allow to diagnose odontogenic maxillary lesions. The incidence of long-term ailments originating in the maxillary sinuses should prompt a detailed assessment of the teeth, especially those after RCT.

Association of a preoperative dental screening approach with 90-day mortality after cardiac valve surgery

Objectives Preoperative dental screening (PDS) before valvular surgery has been adopted widely by cardiac surgeons to prevent poor outcomes associated with infections of oral origin. However, there is limited evidence to guide PDS protocols. This study was designed to compare a focused approach versus a comprehensive approach to PDS to determine its association with 90-day mortality. Study Design A retrospective cohort analysis was performed on 1835 adult patients who underwent elective valvular surgery and PDS at the Massachusetts General Hospital (MGH) and the Brigham and Women's Hospital (BWH) from January 2009 to December 2016. Patients with a history of intravenous drug abuse were excluded. At the MGH (n = 692), PDS involved a detailed dental examination, including diagnostic radiography and definitive therapy for teeth with active and/or chronic disease (comprehensive protocol). At the BWH (n = 1143), PDS consisted of minimal number of diagnostic radiographs limited to symptomatic teeth and intervention only when active signs of disease were observed (focused protocol). Univariate and multivariate analyses were performed to compare 90-day mortality rates after surgery with the 2 different approaches. Results There were no differences in demographic characteristics and baseline comorbidities between the 2 study sites. At the MGH, 340 (49.2%) of 692 patients received dental clearance at the initial visit, with 94.2% (n = 652) undergoing radiography. Dental findings included carious teeth (n = 250; 36.2%), root tips (n = 118; 17%), periodontically hopeless teeth (n = 48; 6.9%), and periapical infections (n = 149; 21.6%); 40 patients (5.8%) were symptomatic. Extractions were performed in 151 patients (21.8%), and 15 (2.2%) had postoperative complications. At the BWH, 1097 of 1143 patients (96%) received dental clearance at the initial visit, with 3.3% (n = 38) undergoing radiography. Dental findings included carious teeth (n = 197; 17.2%), root tips (n = 135; 11.8%), periodontically hopeless teeth (n = 27; 2.4%), and periapical infections (n = 20; 1.7%); 16 patients (1.4%) were symptomatic. Extractions were performed in 38 patients (3.3%), and 4 (0.4%) had postoperative complications. There was no significant differences in 90-day mortality rates between the 2 study sites (10% vs 8.4%; P = .317). This remained unchanged in a multivariate model after adjusting for demographic characteristics and baseline comorbidities (odds ratio [OR] focused vs comprehensive: 1.32; 95% confidence interval [CI] 0.91–1.93); P = .14). Conclusions Despite the differences in PDS protocols at both study sites, there was no significant difference in 90-day mortality rates after valvular surgery. Further randomized comparative prospective studies are needed to validate and expand on these findings.

The oral microbiome of patients with axial spondyloarthritis compared to healthy individuals.

Background. A loss of mucosal tolerance to the resident microbiome has been postulated in the aetiopathogenesis of spondyloarthritis, thus the purpose of these studies was to investigate microbial communities that colonise the oral cavity of patients with axial spondyloarthritis (AxSpA) and to compare these with microbial profiles of a matched healthy population.Methods. Thirty-nine participants, 17 patients with AxSpA and 22 age and gender-matched disease-free controls were recruited to the study. For patients with AxSpA, disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants underwent a detailed dental examination to assess oral health, including the presence of periodontal disease assessed using probing pocket depth (PPD). Plaque samples were obtained and their bacterial populations were profiled using Ion Torrent sequencing of the V6 region of the 16S rRNA gene.Results.Patients with AxSpA had active disease (BASDAI 4.1 ± 2.1 [mean ± SD]), and a significantly greater prevalence of periodontitis (PPD ≥ 4 mm at ≥4 sites) than controls. Bacterial communities did not differ between the two groups with multiple metrics of α and β diversity considered. Analysis of operational taxonomic units (OTUs) and higher levels of taxonomic assignment did not provide strong evidence of any single taxa associated with AxSpA in the subgingival plaque.Discussion. Although 16S rRNA gene sequencing did not identify specific bacterial profiles associated with AxSpA, there remains the potential for the microbiota to exert functional and metabolic influences in the oral cavity which could be involved in the pathogenesis of AxSpA.

Characterizing Diversity of Lactobacilli Associated with Severe Early Childhood Caries: A Study Protocol.

Lactobacilli have been consistently associated with dental caries for decades; however, knowledge of this group of bacteria in the etiology of the disease is limited to quantitative elucidation. Nowadays, explicit identification of oral Lactobacillus species is possible, despite their taxonomic complexity. Here we describe a combined approach involving both cultivation and genetic methods to ascertain and characterize the diversity and abundance of the Lactobacillus population in the oral cavities of children with severe early childhood caries (S-ECC). Eighty 3- to 6-year-old children (40 S-ECC and 40 caries free) who were seeking dental care at the Pediatric Dental Clinic of Bellevue Hospital in New York City were invited to participate in this study. Clinical data on socio-demographic information and oral health behavior were obtained from the primary caregiver. The data included a detailed dental examination, children's medical history, and a questionnaire survey. Combined non-stimulated saliva and supra-gingival plaque samples were collected from each child and cultivated on selective media for quantitative measures of lactobacilli levels. The procedure for Lactobacillus species screening will include the random selection of 50 colonies per plate, extraction of DNA from each colony, and genotyping by arbitrarily primed polymerase chain reaction (AP-PCR). Each unique Lactobacillus AP-PCR genotype will be selected for taxonomic assessment by 16S rRNA gene sequencing analysis. Lactobacillus species will be identified by comparing the 16S rRNA sequences with the Ribosomal Database and the Human Oral Microbiome Database. Meanwhile, the same set of clinical samples will be independently subjected to genomic DNA isolation, 16S rRNA amplification with Lactobacillus genus-specific primers, sequencing, and taxonomic identification, both at genus and species levels with a customized pipeline. The distribution and phylogenetic differences of these Lactobacillus species will be compared between children with or without S-ECC. One of the main objectives of this study is to establish a study protocol for the identification and characterization of lactobacilli in the oral cavity. Future caries risk assessments can include lactobacilli counts (quantitative) and the presence/absence of specific cariogenic genetic signatures of a Lactobacillus species (qualitative) associated with S-ECC.

FRI0168 Comprehensive Analysis of the Oral Microbiome in Axial Spondyloarthritis Reveals Associations with Disease Activity and Periodontitis

BackgroundA wealth of data supports a role for the microbiome in the pathogenesis of spondyloarthtritis (SpA). To date, studies have concentrated on the intestinal tract, which harbours the largest and...

The relationship between term pre-eclampsia and the risk of early childhood caries

Objective: To test the hypothesis that pre-eclampsia is associated with higher incidence of early childhood caries in children aged between 3 and 5 years old.Design: An observational non concurrent cohort study.Setting: Al-Hayat National Hospital, Khamees Mushyat, Saudi Arabic Kingdom.Population: Two hundred children aged 3–5 years who fulfilled the inclusion criteria.Method: A detailed dental examination was carried out for all children enrolled. We obtained all relevant obstetric data from mothers’ and pediatric’s medical records. Thirty cases were excluded due to missing data and therefore, only 170 children were considered for the statistical analysis. Results were tabulated and statistically analyzed.Main outcome measure: Early childhood caries.Results: Sixty-three children (37%) of the 170 were affected with early childhood caries; 6 were delivered to pre-eclamptic and 57 to non pre-eclamptic mothers. Using logistic regression curve, early childhood caries was significantly associated with low birthweight, low Apgar score at 1st min and with the pattern of infant feeding but not with pre-eclampsia. The relative risk for early childhood caries was 2.84 among low birthweight infants (95%CI: 1.47–5.49), 1.95 among non breast fed children (95% CI: 1.11–4.20) and 2.64 among those delivered with an Apgar score less than 5 at 1 minute (95%CI:1.46–4.77).Conclusion: Pre-ecalampsia may not be associated with early childhood caries. A larger study and/or a study addressing the relation between pre-eclampsia and caries inducing lesions may provide more significant results.

Dental Surgery before Liver Transplantation: Is it Really Necessary?

A detailed dental examination and surgical treatment of oral septic foci are recommended in patients awaiting liver transplantation (LT). This standard procedure is based on the idea that patients with untreated dental disease may have an increased risk for post-LT infections. Aim of this study was to evaluate the influence of dental diseases and pre-LT treatment on the infection rates in patients after LT. Patients and methods: From April 2003 until November 2009, 216 patients (154m, 51±11yrs) underwent LT in our centre. The underlying causes were alcohol (45.4%), alcohol + viral hepatitis (6.5%), viral hepatitis (15.3%), biliary tract diseases (14.8%) and others. The patients were divided into 4 groups. Group 1: patients with bad dental status and following dental surgery; group 2: patients with bad dental status without dental treatment; group 3: patients with good dental status; group 4: no pre-LT dental examination available. The medical data were assessed on patients' records and analyzed retrospectively. Results: Mean follow-up after LT was 43±28 months. 58 patients (27%) belonged to group 1, 43 patients (20%) to group 2, 54 patients (25%) to group 3 and 61 patients (28%) to group 4. Bacterial infections, mostly cholangitis and pneumonia, were observed in 49% of all transplanted patients 0-72 months (mean 12 months) after LT. In 46% enterococcus spp. was the most detectable pathogen in the blood and different tissues. However, there was no significant difference in the frequency of bacterial infections and the pathogen spectrum in the 4 different groups. 68 patients died 0-63 months after LT, thereby 25 patients due to bacterial sepsis. Furthermore, significantly (p< 0.001) more patients with alcohol toxic liver cirrhosis suffered from a bad dental status in comparison to patients with other liver diseases. Conclusions: Our data suggest, that there is no significant effect of pre-LT dental status on the outcome of liver transplant patients. Standard dental restoration obviating prophylactic teeth extraction seems sufficient for patients undergoing LT.

The Tokyo Oldest Old Survey on Total Health (TOOTH): A longitudinal cohort study of multidimensional components of health and well-being

BackgroundWith the rapid worldwide increase in the oldest old population, considerable concern has arisen about the social and economic burden of diseases and disability in this age group. Understanding of multidimensional structure of health and its life-course trajectory is an essential prerequisite for effective health care delivery. Therefore, we organized an interdisciplinary research team consisting of geriatricians, dentists, psychologists, sociologists, and epidemiologists to conduct a longitudinal observational study.Methods/DesignFor the Tokyo Oldest Old Survey on Total Health (TOOTH) study, a random sample of inhabitants of the city of Tokyo, aged 85 years or older, was drawn from the basic city registry. The baseline comprehensive assessment consists of an in-home interview, a self-administered questionnaire, and a medical/dental examination. To perform a wide variety of biomedical measurements, including carotid ultrasonography and a detailed dental examination, participants were invited to our study center at Keio University Hospital. For those who were not able to visit the study center, we provided the option of a home-based examination, in which participants were simultaneously visited by a geriatrician and a dentist. Of 2875 eligible individuals, a total of 1152 people were recruited, of which 542 completed both the in-home interview and the medical/dental examination, with 442 completed the in-home interview only, and another 168 completed self or proxy-administered data collection only. Carotid ultrasonography was completed in 458 subjects, which was 99.6% of the clinic visitors (n = 460). Masticatory assessment using a colour-changeable chewing gum was completed in 421 subjects, a 91.5% of the clinic visitors.DiscussionOur results demonstrated the feasibility of a new comprehensive study that incorporated non-invasive measurements of subclinical diseases and a detailed dental examination aiming at community-dwelling individuals aged 85 years or older. The bimodal recruitment strategy is critically important to capture a broad range of health profiles among the oldest old. Results form the TOOTH study will help develop new models of health promotion, which are expected to contribute to an improvement in lifelong health and well-being.Trial RegistrationThis study has been registered in the UMIN-Clinical Trial Registry (CTR), ID: UMIN000001842.

Dental disease in a group of adult mentally handicapped patients

A community of 90 long-stay mentally handicapped, adult, female patients was dentally assessed under difficult ward conditions. Tentative treatment plans were drawn up and a subsequent detailed dental examination supported the value of the original brief assessment. The general level of dental health was found to be very poor, and reflected a need for a much deeper appreciation of oral hygiene and of dental procedures in general among those working with the handicapped. The range of possible treatment and the manner in which it was carried out was affected by the patients' general condition and behaviour. An indication is given of the considerable manpower needs which were required to establish a minimum state of dental fitness.

The differentiation of toothed marks: report of a case of special forensic interest.

The first case reported in the literature where a toothed weapon was found in the murder room and therefore suspected of causing injuries is described. Detailed dental examination showed conclusively that the toothed marks were bites, which proved important in differentiating between a sadistic attack with a saw and an attempted drunken sexual arousal. The case demonstrates that a full dental evaluation, as described, is mandatory in any case of wounding where a toothed cause is suspected. The value of the acetate film technique for speedy and accurate reproduction of bite marks is illustrated.