Deterioration Of Oral Health Research Articles

Oral Health of COVID-19 Patients Using Extracorporeal Membrane Oxygenation: A Clinical Study of 19 Cases.

The oral health of coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is an important issue in treatment of respiratory failure. We retrospectively investigated the oral health history of severe COVID-19 patients who received extracorporeal membrane oxygenation (ECMO) from April 2020 to December 2020 using the oral assessment guide from Fukuoka University (OAG-F). Nineteen consecutive patients (median age: 62 years) were divided into two groups according to survival (survivors, n = 12; non-survivors, n = 7). A univariate analysis revealed no significant differences between the groups in sex, age, body mass index (BMI), or the number of remaining teeth, whereas the ECMO assistance of non-survivors (median: 34 days) was prolonged in comparison to survivors (median: 8 days; p < 0.05). Among the factors of OAG-F, significant differences were observed between the groups in the conditions of the saliva, mucous membrane, and gingiva. The total scores in non-survivors (median: 19) were significantly higher in comparison to survivors (Median: 15.5), suggesting that the frequency of oral health deterioration was higher in non-survivors (p < 0.05). Taken together, these findings suggest that poor oral health is associated with mortality in COVID-19 patients receiving ECMO in the ICU.

Oral Health in Late Life: Challenges and Solutions

Older adults face a unique challenge in maintaining their oral health due to an increased disease burden, polypharmacy, functional impairment and other reasons. The five papers in this symposium describe the oral health issues in various groups of older adults and discuss different approaches to improve oral health for older adults. Using data from the Population Study of Chinese Elderly in Chicago, the first paper examined the relationship between self-reported discrimination and oral health related quality of life and investigated how resilience mediated such a relationship among foreign-born older Chinese Americans. The second paper described the oral health concerns and related treatment needs in older adults receiving palliative care using a mixed method design. The third paper demonstrated how to use behavior change techniques to improve oral self-care skills of individuals with mild dementia and support their family caregivers. The fourth paper described a project that integrates the age-friendly health system's principles into specialty dental care to address healthy aging and oral health. This initiative helped prevent and change the false belief that aging inevitably involves deterioration in oral health. The fifth paper described the impact of COVID-19 on the management of oral health problems and access to dental care in older adults. Transformative changes in care delivery and the impact of vaccination on access to care was also explored. This symposium helps better understand the oral health needs in older adults and provides new evidence to improve oral health for these individuals.

Adopting the 4Ms Framework and Age-Friendly Concepts Into Dental Care

We report on launching a dental initiative that addresses healthy aging and oral health, focusing on prevention and changing the false belief that aging inevitably involves deterioration in oral health. Our project integrates the age-friendly health system's principles into specialty dental care at Eastman Institute for Oral Health, URMC. We established an oral health-centered framework with project elements of the 4Ms - what matters, medication, mentation, and mobility. We developed pilot 4Ms templates integrated into dental charts to implement healthy-aging key oral health processes, including oral health assessment, treatment planning, and oral hygiene support. We engaged all members of the dental team through educational sessions for providing care for patients affected by Alzheimer’s disease and related dementias. We leveraged on locally available interdisciplinary resources and the collaboration reflecting undergoing efforts at the University of Rochester Division of Geriatrics and the Finger Lakes Geriatric Education Center, a Geriatric Workforce Enhancement.

OralDisk: A Chair-Side Compatible Molecular Platform Using Whole Saliva for Monitoring Oral Health at the Dental Practice.

Periodontitis and dental caries are two major bacterially induced, non-communicable diseases that cause the deterioration of oral health, with implications in patients’ general health. Early, precise diagnosis and personalized monitoring are essential for the efficient prevention and management of these diseases. Here, we present a disk-shaped microfluidic platform (OralDisk) compatible with chair-side use that enables analysis of non-invasively collected whole saliva samples and molecular-based detection of ten bacteria: seven periodontitis-associated (Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) and three caries-associated (oral Lactobacilli, Streptococcus mutans, Streptococcus sobrinus). Each OralDisk test required 400 µL of homogenized whole saliva. The automated workflow included bacterial DNA extraction, purification and hydrolysis probe real-time PCR detection of the target pathogens. All reagents were pre-stored within the disk and sample-to-answer processing took < 3 h using a compact, customized processing device. A technical feasibility study (25 OralDisks) was conducted using samples from healthy, periodontitis and caries patients. The comparison of the OralDisk with a lab-based reference method revealed a ~90% agreement amongst targets detected as positive and negative. This shows the OralDisk’s potential and suitability for inclusion in larger prospective implementation studies in dental care settings.

Impact of COVID-19 on Oral Health

In December 2019 an outbreak of COVID19 occurred which is a severe acute respiratory disorder. Many succumbed to this global pandemic and many are still fighting the after effect of it. The virus directly affects the immune system especially of lungs. Therefore, the people who already have compromised immunity are at the very risk. The first symptoms to appear in COVID19 patients are ageusia and anosmia while treating the COVID19 patient’s certain practices are followed which aid in rapid oral health deterioration like oxygen mask, ventilators, heavy dose of medicines. Certain medicines used in treatment also precipitate poor oral health like bleeding gums, oral ulceration and dry mouth are the most common oral health problems faced after COVID19 recovery. COVID directly affects the immune system thereby making way for opportunistic infections like mucormycosis. Mucormycosis offers a severe burden on oral and general health affecting the standard of living and cause death in severe cases. Sinusitis, Periodontitis, black staining across the bridge of nose and sinus, localized discomfort and unbearable diplopia and refractive errors along with embolism and necrosis are seen in mucormycosis patients. Treatment of mucormycosis consists of surgery and replacement of lost structures Patients with compromised immunity need to take proper precautions during and after COVID.

Analysis of the Association between COVID-19 and Dental Visits in Children and Adolescents through Big Data

This study was conducted to investigate changes in dental visits in children and adolescents due to COVID-19. Based on the data provided by the Korea Health Insurance Review and Assessment Service, the number of dental visits among children and adolescents from January 2019 to August 2020, and the rate change according to Korean disease classification in 2019 and 2020 were analyzed by month and region. From January to August 2020, compared to the same period in 2019, the total number of visits to dental clinics and dental hospitals among children and adolescents decreased by 642,202 times (16.3%) in the 0 - 9 years old group, and 313,488 times (9.2%) in the 10 - 19 years old group. During the same period, the decreases due to Z29 (Need for other prophylactic measures) decreased by 118,219 times (34%) in the 0 - 9 years old group and 83,944 times (31%) in the 10 - 19 years old group, showing the greatest change. It is analyzed that overall dental service of children and adolescents has decreased due to COVID-19, and this may lead to deterioration of oral health of children and adolescents in the future, and this study can be used as a reference in case of an infectious disease such as COVID-19 in the future.

Impact of COVID-19 on Czech Dentistry: A Nationwide Cross-Sectional Preliminary Study among Dentists in the Czech Republic.

This work evaluates the impact of the COVID-19 pandemic on Czech dentistry from March 2020 to March 2021. The assessment was based on questionnaires filled out by 3674 Czech dentists representing 42.6% of practicing dentists in the country. During March–May, 2020 (the first COVID-19 wave), 90.7% of dental practices remained open; however, only 22.8% of the practices continued to operate with no changes, 46.5% had fewer patients, 21.4% treated only acute cases, and 3.8% were closed. During September 2020–May 2021 (the second wave of COVID-19), 96.1% of dental practices remained open, 60.8% operated with no changes, 34.5% had fewer patients, 0.8% treated only acute cases, and 0.5% were closed. The reasons leading to the closure of Czech dental practices during the whole pandemic were a shortage of personal protective equipment (50.5%), a COVID-19 outbreak in the workplace (24.5%), fear of a possible self-infection (24.0%), and quarantine (20.5%). The time range of Czech dental practices closure during the whole pandemic was: 1–2 weeks (49.9%), 2–4 weeks (21.2%), and >1 month (0.8%). The greatest professional difficulties of Czech dentists during the pandemic were crisis operating management (55%), health safety and hygiene concerns (21%), shortage of personal protective equipment (21%), and difficulty working with the protective equipment (15%). In addition, 47.3% of dentists also observed a declining interest in preventive dental care, and 16.9% of them observed worse oral care of patients. These results show that despite the lack of protective equipment, dental care was maintained throughout the pandemic. Additionally, the pandemic negatively affected the patients’ approach to dental care, indicating a deterioration in oral health as a possible delayed outcome of the COVID-19 pandemic.

Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA

Preventing deterioration of oral health in older age can be crucial for survival. We aimed to examine associations of oral health problems with all-cause, cardiovascular disease (CVD), and respiratory mortality in older people. We used cohort data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) Study (USA) (N = 3075, 71–80 years). Follow-up was 9 years (BRHS) and 15 years (HABC Study). Oral health comprised tooth loss, periodontal disease, dry mouth, and self-rated oral health. Cox regression was performed for all-cause mortality, competing risks for CVD mortality, and accelerated failure time models for respiratory mortality. In the BRHS, tooth loss was associated with all-cause mortality (hazard ratio (HR) = 1.59, 95% CI 1.09, 2.31). In the HABC Study, tooth loss, dry mouth, and having ≥ 3 oral problems were associated with all-cause mortality; periodontal disease was associated with increased CVD mortality (subdistribution hazard ratio (SHR) = 1.49, 95% CI 1.01, 2.20); tooth loss, and accumulation of oral problems were associated with high respiratory mortality (tooth loss, time ratio (TR) = 0.73, 95% CI 0.54, 0.98). Findings suggest that poor oral health is associated with mortality. Results highlight the importance of improving oral health to lengthen survival in older age.

Changes of Dentition State in Leukemic Patients during Chemotherapy.

A number of systemic diseases including hematological disorders have manifestations in the oral cavity region. These manifestations may often represent early signs of the underlying hematopoietic disease and occur frequently in leukemia. Despite the fact that leukemia has long been known to be associated with oral health deterioration, the available literature on this topic consists mostly of case reports, without data to conclude these. The aim of the study was to assess dentition state in leukemic patients during one cycle of chemotherapy and its correlation with blood parameters. The study included 102 adults treated because of leukemia at the Clinic of Haemato-Oncology and Bone Marrow Transplantation at the university hospital in Lublin, Poland. The sample group consisted of 51 women and 51 men aged 22 to 72 (54.07 ± 10.33) with following diagnoses: Acute myelogenous leukemia (AML)—55 patients (53.92%), Chronic lymphocytic leukemia (CLL)—17 patients (16.67%), Acute lymphoblastic leukemia (ALL)—16 patients (15.69%), Chronic myelogenous leukemia (CML)—10 patients (9.80%), Acute promyelocytic leukemia (APL) —3 patients (2.94%), Chronic hairy cell leukemia (HCL)—1 patient (0.98%). DMFT index was used to assess dentition state. After the cycle of chemotherapy, their dentition state changed in terms of decayed, missing and filled teeth and correlated with hematological parameters. Adult patients with leukemia have high dental treatment needs, and high number of missing teeth; thus, a comprehensive and fast dental treatment is necessary to avoid systemic complications and ensure better quality of life.

Dental anxiety among Wisma Lincoln University College community

Dental anxiety is common among people of all ages, which results in delay and avoidance of dental visit and eventually deterioration of oral health. The aim of this study is to assess the dental anxiety level among the community in Wisma Lincoln University College. A cross-sectional study was carried out from April to December 2018. A total of 186 participants were included in this study. The Modified Dental Anxiety Scale (MDAS) was used to assess participants’ dental anxiety level. The prevalence of participants with severe anxiety level was 16.7% (n=31), with Indian female being the highest number (n=6, 20%). Participants felt most anxious if they were to receive a local anesthetic injection, with a mean score of 2.04 for male and 3.76 for female. With regards to the aspects of dental treatment that make participants anxious, 74.7% (n=139) of the participants would feel anxious about extraction, followed by pain arising from treatment (63.4%, n=118) and fear of injury caused by dental instrument (60.8%, n=113). In conclusion, 16.7% of the community in Wisma Lincoln University College were highly anxious, with Indian female being most anxious (20%).

Association between oral health-related quality of life and general health among dental patients: a cross-sectional study.

SummaryGlobally, the prevalence of chronic diseases is increasing significantly, causing deterioration of oral and general health and therefore quality of life. The present study was designed to assess the relationship between oral health-related quality of life and general health of dental patients. The study is part of the University’s plan to achieve the United Nations Sustainable Development Goals number 1, 3, 4 and 5. Dental school students’ satisfaction with their early engagement in clinical activities and research work was also evaluated. A convenience sample of 600 subjects attending dental clinics aged ≥18 years of both sexes was included in the study. Second-year dental students conducted the study under the supervision of public health staff members over two successive academic years (2015–2016 and 2016–2017). Oral health-related quality of life was assessed using the Dental Impact on Daily Living (DIDL) questionnaire. Blood pressure, random blood glucose level, body mass index, and waist circumference were measured as indicators of general health. There were statistically significant inverse correlations between DIDL scores and both mean blood pressure (r = −0.215, p < 0.001) and mean blood glucose level (r = −0.272, p < 0.001). Non-significant inverse correlations were observed between DIDL scores and both body mass index (r = −0.062, p = 0.131) and waist circumference (r = −0.040, p = 0.340). Students’ satisfaction scores with research activities were high, ranging from 75.9% to 78%. Dentists must raise patients’ awareness about the importance of oral health and its impact on their quality of life and general health. Participation of dental students in dental research is encouraged even in their early academic years.

Association between oral health-related quality of life and general health among dental patients: a cross-sectional study

Abstract Globally, the prevalence of chronic diseases is increasing significantly, causing deterioration of oral and general health and therefore quality of life. The present study was designed to assess the relationship between oral health-related quality of life and general health of dental patients. The study is part of the University’s plan to achieve the United Nations Sustainable Development Goals number 1, 3, 4 and 5. Dental school students’ satisfaction with their early engagement in clinical activities and research work was also evaluated. A convenience sample of 600 subjects attending dental clinics aged ≥18 years of both sexes was included in the study. Second-year dental students conducted the study under supervision of public health staff members over two successive academic years (2015–2016 and 2016–2017). Oral health-related quality of life was assessed using the Dental Impact on Daily Living (DIDL) questionnaire. Blood pressure, random blood glucose level, body mass index, and waist circumference were measured as indicators of general health. There were statistically significant inverse correlations between DIDL scores and both mean blood pressure (r = −0.215, p < 0.001) and mean blood glucose level (r = −0.272, p < 0.001). Non-significant inverse correlations were observed between DIDL scores and both body mass index (r = −0.062, p = 0.131) and waist circumference (r = −0.040, p = 0.340). Students’ satisfaction scores with research activities were high, ranging from 75.9% to 78%. Dentists must raise patients’ awareness about the importance of oral health and its impact on their quality of life and general health. Participation of dental students in dental research is encouraged even in their early academic years.

Postponed Dental Visits during the COVID-19 Pandemic and their Correlates. Evidence from the Nationally Representative COVID-19 Snapshot Monitoring in Germany (COSMO).

(1) Background: The COVID-19 pandemic is accompanied by various societal and economic challenges. Furthermore, it is associated with major health challenges. Oral health is a key component of health. Therefore, both curative and preventive dental visits are important during pandemics. Since there is a lack of nationally representative studies focusing on postponed dental visits and their correlates during the COVID-19 pandemic, we aimed to fill this gap in knowledge; (2) Methods: Cross-sectional data (wave 17) were collected from a nationally representative online-survey (COVID-19 Snapshot Monitoring in Germany (COSMO)) conducted in July 2020. The analytical sample consisted of 974 individuals (average age was 45.9 years (SD: 16.5, from 18 to 74 years)). The outcome measure was postponed dental visits since March 2020 (yes; no) due to the COVID-19 pandemic. Furthermore, the type of postponed dental visits was recorded (check-up/regular dental examination; pain/dental complaints; planned therapy); (3) Results: 22% of participants reported to have postponed dental visits due to the COVID-19 pandemic since March 2020, whereas 78% of individuals did not report postponed visits (“no, attended as planned”: 29.2%; “no, examining pending”: 44.9%; “no, other reasons”: 3.9%). Among individuals who reported postponed dental visits, 72% postponed a “check-up/regular dental examination”, whereas 8.4% postponed a dental visit despite “pain/dental complaints” and 19.6% postponed “planned therapy”. Furthermore, multiple logistic regressions showed that the likelihood of postponed dental visits was positively associated with being younger (aged 65 and older, OR: 0.43, 95% CI: 0.22–0.85; compared to individuals 18 to 29 years), and higher affect regarding COVID-19 (OR: 1.36, 95% CI: 1.13–1.64); (4) Conclusions: Our study showed that more than one out of five individuals postponed a dental visit—particularly check-ups and regular dental examination—due to the COVID-19 pandemic since March 2020. Several correlates of these postponed visits have been identified. This may help identify and address individuals at risk for deterioration of oral health amplified by postponed dental visits.

Impact of Oral Health on Quality of Life and Subjective Well-Being in Community-Dwelling Older Adults in Mexico

Objective: Associate the impact of oral health with quality of life and subjective well-being in the community-dwelling older adults in Mexico. Methods: Non-random sample; 326 subjects: age collected (60-69 / ≥ 70); gender (male / female); marital status (couple / no partner); schooling (0-6 years / ≥7); income for basic needs (yes / no); no depression (GDS-15), no cognitive impairment (MMSE) and comorbidity (no disease / ≥ 1 disease) to control biases. Oral conditions; Caries index (ICPOD) WHO criteria: Very low-Low; Moderate and High. Need for dental prostheses (WHO Manual): No prostheses needed (27-28 natural teeth or fixed / removable / total combination; Need prosthesis: 2-28 tooth without replacement. Xerostomia (Thomson Inventory); moderate to severe xerostomia > 17 points. Dependent variables: Quality of Life Related to Oral Health (GOHAI); 57-60 points: High perception. Subjective well-being: Moral Scale of the Geriatric Center of Philadelphia (PGCMS): Low score (0-11). Results: Age: 71.84 ± 7,278; female / male (70.9 / 29.1%). Controlling confounding factors, multiple logistic regression showed that the need for multi-unit or total prostheses; high CPOD index; severe xerostomia; and low perception of well-being subjective, were associated with low GOHAI scores: P = 0.000; P = 0.004; P = 0.003; P = 0.02 respectively. Subjective well-being only was associated with severe xerostomia and low CVRSO perception: P = 0.0 1; P = 0.02 respectively. Conclusion: Taking into account various confounding factors, the Quality of Life related to Oral Health was the most affected by the deterioration of oral health.

Salivary microbial changes during the first 6 months of orthodontic treatment.

BackgroundOrthodontic treatment is widely used to treat malocclusion. However, the influence of treatment on the oral microbiome remains unclear. In this study, we investigated salivary microbial changes in patients undergoing orthodontic treatment.MethodsIn total, 19 orthodontic patients participated in this study. Saliva samples were collected at the following three timepoints: before (T0) and 3 months (T1) and 6 months (T2) after the placement of orthodontic appliances. High-throughput sequencing was performed based on the 16S rRNA gene V4 region.ResultsThe phyla of Proteobacteria, Bacteroidetes, Firmicutes, Actinobacteria and Fusobacteria were predominant. Observed Species, Chao1 and ACE, which represent α diversity, were significantly decreased at T1 and subsequently increased at T2. In addition, the β diversity at T1 based on the Bray-Curtis distances differed from T0 and T2. The relative abundances of Prevotella, Porphyromonas and Peptostreptococcus were decreased with treatment, whereas those of Capnocytophaga and Neisseria exhibited the opposite results. In total, 385 of 410 operational taxonomic units were shared at T0, T1 and T2. The co-occurrence networks with hub nodes at T1 were the most complex.ConclusionOrthodontic treatment temporarily affected the saliva microbial community. This dynamic alteration in species did not induce deterioration in oral health. Oral hygiene instructions were necessary and should be emphasized during each visit. Further studies with longer observation periods and more participants are required.

Oral conditions in the community patient: part 2-systemic complications of poor oral health.

Oral health has a symbiotic relationship with general health, with oral disease recognised to have an adverse effect on the overall systemic health of a patient. Deterioration in oral health has been shown to have an impact on the severity of chronic systemic diseases, nutrition, hydration and psychological and social wellbeing. Part 1 of this mini-series explored the common oral conditions that community patients may present with, and the role of the nursing team in aiding the prevention, diagnosis and management of these conditions. Following on from that, this article discusses the links between oral and general health, and preservation of a patient's quality of life. This article also aims to support nurses' knowledge on how to assess the oral health needs of patients, support oral care provision, how to access acute and elective dental services and signpost to additional supportive resources.

Oral chronic graft-versus-host disease: What the general dental practitioner needs to know

BackgroundLong-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers. MethodsThe authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD). ResultsChronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management. ConclusionsGeneral dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration. Practical ImplicationsFrequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.

Oral health as an opportunity to support isolated people with dementia: useful information during coronavirus disease 2019 pandemic

We would like to deliver two unpublished findings that we believe offer useful information in the fight against coronavirus disease 2019 (COVID-19), especially for specialists who support people with dementia. Recent research has revealed an association between oral health and the lethal pneumonia caused by COVID-19. First, the presence of chronic inflammation in the oral cavity is associated with increased susceptibility to COVID-19 infection.1 Second, in acute pneumonia due to COVID-19 and bacterial pneumonia due to aspiration of oral bacteria, septic shock and thrombus formation can lead to a higher fatality rate when combined with decreased cellular immune function and a cytokine storm.2 It is well known that the risk for severe illness from COVID-19 increases with age, with older adults at the highest risk. Accordingly, oral health is a critical issue for the older people during the COVID-19 pandemic. However, oral health research on community-dwelling elderly individuals with dementia is sparse. Additionally, in overpopulated urban areas, the dental care needs of people with dementia are reportedly difficult to ascertain.3 To explore the real-world oral health of older people with dementia, we have launched two research frameworks. First, for an epidemiological survey, we offered a new option: home visits by the research team.4 This approach increased opportunities for community-dwelling older people, especially those who tend to be socially withdrawn and would normally be overlooked, to participate in the epidemiological survey. The results of this survey indicated that participants who had asked to complete a home-visit survey had worse oral health and had visited a dentist less frequently than those who had asked to complete a conventional survey. Second, in a clinical survey, we formed a team with multiple dentists and one psychiatrist to revisit the older people with cognitive impairment who were found in the epidemiological survey as being at high risk for daily life disorders. At participants’ homes, the psychiatrist evaluated their Clinical Dementia Rating, and the dentists examined their oral function, including the periodontal inflamed surface area (PISA). PISA is a method of quantifying the inflammatory burden of periodontal disease. The larger an individual's PISA is, the greater the bacteraemia, systemic inflammatory response, and cross-reactivity caused by periodontal disease.5 Table 1 shows the clinical survey results up to the time just before COVID-19 interrupted these visits. The results indicated that PISA was significantly larger in individuals with cognitive decline than in those with normal cognition, meaning that individuals with cognitive decline are unknowingly living with chronic inflammation in their oral cavity (Table 1). Additionally, individuals with cognitive decline with poor oral health had worse nutritional status because of neglected oral defects. Also, people with cognitive decline had objective oral health deterioration as assessed by dentists, but they were not receiving primary dental care. Our findings indicate that homebound elderly people with dementia are at risk of pneumonia via poor oral health during the COVID-19 pandemic. Accordingly, intervention targeting the oral health of community-dwelling older people might be an effective protective measure against COVID-19. In conclusion, collaborations between geriatric psychiatrists and dentists have great value. This work was supported by a grant from JSPS KAKENHI (no. JP19K10438). All authors contributed to the development of the study concept and design, the acquisition of subjects and/or data, analysis and interpretation of data, and manuscript preparation. All authors agree to be held accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

High Altitude and Its Effects on Oral Health: A Review of Literature

Health deterioration at high altitudes is related to many pathophysiological processes. The literature contains much evidence describing the multiple factors responsible for this deterioration, including hypoxia, decreased oxygen saturation, and decreased barometric pressure. An increase in the levels of oxidative stress at high altitudes can lead to many serious health events, although the human body may be able to adapt to such changes in the case of people who are accustomed to living at a high altitude. The pathophysiological processes at high altitudes also have adverse effects on oral tissue health. The aim of this review is to summarize the major published findings about oral health deterioration of living in and travelling to high-altitude areas. Most studies have noted the adverse effects of prolonged exposure to hypoxia at high altitudes on oral tissues, including the salivary gland, periodontal tissue, gingival crevicular fluids, and jawbone. These changes include increases in the levels of inflammatory mediators and periodontal inflammation parameters. In addition, the incidence and severity of dental fluorosis is higher in residents of high-altitude areas. Abrupt changes in barometric pressure in people who travel to high altitudes may cause dental barotrauma and appear to increase sensitivity to pain (barodontalgia). In conclusion, it is important to consider that travelling to and living in high-altitude areas is a possible risk factor for multiple oral diseases.

Implementation of an online treatment planning exercise focused on vulnerable patient groups.

The coronavirus disease 2019 (COVID-19) pandemic presented formidable challenges in our ability to impart in-person extra-mural clinical training, including the Geriatric and Special Needs Program, to a group of 20 fourth-year dental students. A new course delivery format was developed wherein students used a validated Rapid Oral Health Deterioration (ROHD) risk assessment tool to critically appraise clinical case information relating to a young adult with special needs. In the alternative virtual educational approach that was created, students applied an interprofessional practice concept leading to patient treatment planning outcomes. Providing adequate information, additional reading resources, a response template, clear instructions and a process-oriented assessment policy all ensured a good level of participation from students in the alternative learning format. An association was noted between students' staging of risk for ROHD and their subsequent recommendations for treatment.