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Biomedical subjects

J Pietrokovski

Publications and source records attributed to J Pietrokovski.

11 recordsLinked to original sources

Oral findings in elderly nursing home residents in selected countries. 1.

In order to determine the influence of culture, individual idiosyncrasy, social and economic conditions as well as the importance of past and current dental care on oral health, the oral conditions of 610 patients in seven old age homes were evaluated in four countries: USA, Peru, Argentina and Israel. The patients included in this study were examined by clinicians who had undergone training and calibration sessions. The seven institutions surveyed have a large range of physical facilities, economic levels, and a variety of quantity and quality among medical, dental and ancillary staff. There were marked differences as to philosophy of treatment and scope for the dental care of the residents. A subjective impression by the examiners is that old age home administrators do not regard the dental needs of the residents to be among their higher priorities. Dental care is considered expensive and requires special equipment and exclusive physical space on the institutional premises. Of the 610 residents 419 were women and 191 men, with an average age of 80 years. The mean number of years of schooling was six. Sixty-two percent of the examinees were widowed, 21% were married, 1% single, 2% divorced, and 5% of unknown or undeclared status. The main orodontal characteristic of the population surveyed was partial or full eduentulousness. Of the total population (610 examinees) only three patients possessed a full complement of natural, unrestored teeth. Twelve examinees had 28 unit dentition, partly natural teeth and partly restored with plastic fillings, fixed prostheses, crowns or pontics. Three hundred and one patients (49%) of the examined population were totally edentulous, 249 (41%) wore sets of complete dentures and 52 (8%) did not wear any prosthetic restoration or replacement.

Aged

Oral findings in elderly nursing home residents in selected countries. 2. Soft tissue lesions and denture wearing habits.

This paper demonstrated that 38% of the 610 examinees at seven institutions in four countries have soft tissue lesions. Seventy to eighty percent of the detected lesions were of the erythematous type. This incidence was found at institutions with and without attending dentists, in denture and non-denture users, in dependent and independent patients. Tissue lesions in denture wearers were four times as many as in non-denture wearers. The percentage of inflammatory lesions in both denture and non-denture wearers was considerably higher at institutions with no attending dental personnel when compared with those with dental care facilities. Where patients depended on the staff and/or their relatives for their personal hygiene, a sharp increase in pathological findings was seen when compared to independent dwellers. The nursing staff and the relatives know very little about the oral problems of the elderly residents. There was no uniform policy about telling patients when to wear their removable dentures and patients did not always follow instructions when they were given. Many patients sleep with their upper denture while the lower one is removed for the night. Patients sometimes sleep in the dentures and sometimes remove one or both dentures for varying periods of time. The high percentage of soft tissue lesions and erratic denture wearing habits point to neglect and insufficient oral care toward the geriatric population studied.

Aged

Occlusion between removable dentures and natural teeth.

Study casts on thirty-five partially edentulous patients were analysed at their arch level and at the interarch levels. At the arch level the crest of the residual ridge is located lingually to the position of the remaining teeth in the maxilla as well as in the mandible. The spatial interarch relationship between the residual edentulous ridge and the antagonist natural teeth in the buccolingual plane indicated that the crest of the residual ridge is lingual to the occlusal surfaces of the antagonist teeth. In the maxilla the positioning of the artificial teeth in the area previously occupied by the natural extracted teeth will place the denture teeth far buccal as well as away from the crest of the residual ridge. Other possibilities are to place the artificial teeth in a cross bite relation or to eliminate the buccal cusps of the replacement teeth. In the mandible the denture teeth can be placed at the position occupied formerly by the natural teeth.

Alveolar Process

The residual ridge in partially edentulous patients.

The residual ridge which forms after the extraction of teeth is characterized by a loss of substance when compared with the dentulous ridge. The residual ridge shrinks in an apical direction and shifts lingually. This remodeling pattern takes place mainly at the expense of the bony crest, the buccal plate of the alveolar process, and the gingival tissues covering it. The lingual positioning of the residual ridge crest was observed in maxillary and mandibular specimens in all the regions of the jaws and regardless of the number of teeth missing. Cross sections of the residual ridge were square, parabolic, or tapered. The base of the pontic for a fixed partial denture should be made buccolingually as the mirror image of the crest of the residual ridge it is to contact, and it should follow mesiodistally the contour and length of the clinical crowns of the adjacent abutment teeth.

Alveolar Process

Clinical procedures for improving veneered metal crowns.

Satisfactory design and preparation of the veneer window presuppose that a perfect or a near-perfect preparation of the tooth has been made. The window is not just a cutout and is not the responsibility of the laboratory technician. Whenever optimum gingival health, a satisfactory esthetic result, and a long-lasting restoration are desired, it is worthwhile to carefully check and, if necessary, adjust the veneer window directly in the mouth before the veneer is added. This is especially important in restorations that extend below the gingival margin.

Acrylic Resins

The bony residual ridge in man.

The bone which fills in the socket after tooth extractions was investigated in 120 dry skull specimens and 100 radiographs in which one or more teeth had been missing for at least three months. The bony content of the socket was of the trabecular type. This trabecular bone was well differentiated from the adjacent cortical bony plates. In buccolingual sections, the residual crest was formed by dense trabecular bone, clearly differentiated from the cortical plates as well as from the less dense trabecular bone that was deeper within the former sockets. From the occlusal aspect, the crest of the edentulous surface had shifted lingually when compared to the original position of the teeth before extractions. From the lateral aspect, the residual ridge formed a concavity or went straight between the alveolar crests of the adjacent remaining teeth. When several teeth were missing, the concavity was more pronounced than when a single tooth was missing.

Adult