Biomedical subjects
Ronald L Ettinger
Publications and source records attributed to Ronald L Ettinger.
Rational dental care: part 1. Has the concept changed in 20 years?
The concept of "rational dental care" was developed 20 years ago when it became clear that idealized treatment plans for frail and functionally dependent older adults were often inappropriate. This first in a series of 2 articles reviews the reasons for developing the concept.
Rational dental care: part 2. A case history.
Treatment planning and managing the care of an elderly, frail patient can be complicated by a variety of modifying factors. To understand the patient"s needs, one must understand the environment in which the patient functions. This second in a series of 2 articles presents a case history of a frail, older adult to illustrate some of the social, medical and community problems that are involved in caring for elderly persons.
Prevention of demineralization by CO2 and Er,Cr:YSGG laser irradiation of overdenture abutments.
PURPOSE: To assess the effects of Er,Cr:YSGG and CO2 laser irradiation on the prevention of demineralization of overdenture abutments. METHODS: 32 human canines, premolars, and molars were acquired, cleaned, and scaled. They were randomly divided into two groups. Each tooth had two windows on the occlusal cut dentin. One window on each tooth was irradiated by either Er,Cr:YSGG or CO2 laser, while the other window served as a control. After pH cycling at pH 5.5 for 18 days and pH 4.7 for 16 days, the teeth were sectioned and analyzed using polarized light microscopy with water as the imbibing medium. RESULTS: The Er,Cr:YSGG irradiated dentin had a mean lesion depth of 207 +/- 27 microm while its control had a mean lesion depth of 209 +/- 34 microm. The CO2 laser irradiated dentin had a mean lesion depth of 185 +/- 24 microm while its control had a mean lesion depth of 205 +/- 22 microm. Based on paired t-tests Er,Cr:YSGG laser irradiation of dentin did not reduce demineralization when compared to the controls (P= 0.81), while CO2 laser irradiation of dentin showed that it helped reduce demineralization when compared to the controls (P= 0.025).
Impact of dry mouth on oral symptoms and function in removable denture wearers in Japan.
OBJECTIVE: The purpose of this study was to determine the association of dry mouth with oral symptoms and function, such as denture instability, discomfort, soreness in denture-bearing tissue, and dissatisfaction with chewing, tasting, or speaking in removable denture wearers. STUDY DESIGN: The subjects were 493 removable denture wearers with a mean age of 67.3 years. Perception of oral dryness was measured by a questionnaire. A multiple logistic regression analysis was used to determine the effect of the dry mouth on oral symptoms and function after controlling for age and gender. RESULTS: Oral dryness during eating was related to dissatisfaction with chewing (odds ratio, 10.5; P < .001) and speaking (odds ratio, 3.5; P < .05) and overall dissatisfaction (odds ratio, 6.3; P < .01) in complete denture wearers. Feeling of dry mouth was likely to be associated with soreness in denture-bearing tissues in both complete and removable partial denture wearers. CONCLUSIONS: There was a significant association of the perception of dry mouth among a group of denture wearers with oral symptoms and function.
Effect of topical fluoride and fluoride varnish on in vitro root surface lesions.
PURPOSE: To evaluate the effect of a fluoride varnish on demineralization and remineralization of root surfaces in vitro. METHODS: 80 caries-free teeth were selected from a large pool of extracted anterior and premolar teeth from elderly patients. Acid resistant nail varnish was painted on all surfaces except for a window (l x 4 mm) on the buccal or lingual root surfaces. Teeth were randomly divided into four treatment groups: CONTROL: washed with deionized/distilled water; Daily gel: treated with Karigel-N (5,000 ppm) for 4 minutes daily; Weekly gel: treated with Karigel-N for 4 minutes weekly; and Weekly varnish: treated with Duraflor (22,600 ppm) weekly (the varnish was removed 24 hours after each application). Teeth were then placed in a cycle of demineralization (6 hours at pH 4.3) and remineralization (17 hours at pH 7.0) for 21 days. Half the specimens of each group were brushed with no dentifrice for 10 seconds twice daily. Specimens were evaluated under polarized light microscopy and contact microradiography. The depth of each lesion and width of the remineralization bands were measured. An ANOVA model was used to assess the effect of different treatments. RESULTS: The control group had the deepest lesions and the daily gel group had the shallowest lesions. The weekly varnish group was found to have significantly shallower lesions than the weekly gel group. The varnish brushing subgroup had significantly deeper lesions than varnish non-brushing subgroup (P = 0.01). Remineralization bands were detectable in most lesions. There was no significant difference in band width between different groups (F = 0.634, P = 0.594). However, a significant difference was found when remineralization bands were calculated as percentage of lesion depth between different groups (F = 4.24, P = 0.001). The varnish non-brushing subgroup had significantly higher percentage than the control group, but daily gel non-brushing had the highest percentage. Brushing was a significant factor in the varnish group. Lesions were significantly shallower in the non-brushing varnish subgroup.
Postprocedural problems in an overdenture population: a longitudinal study.
This study reports on endodontic and other post-procedural problems experienced by overdenture patients from 1973 to 1996. There were 395 subjects enrolled in the study; 273 fulfilled the recall criteria. At recall, all subjects were examined by a single examiner, and appropriate maintenance care was performed. The 273 subjects had 666 abutments and 626 endodontically treated teeth; of these, 51 subjects had postprocedural problems in 81 teeth. Thus, 87.1% of the endodontically treated teeth had no postprocedural problems, and 12.9% had postprocedural problems. Of the subpopulation with postprocedural problems, the most common problem was endodontically treated teeth developing periradicular lesions (37.0%) because of recurrent caries causing loss of the restoration sealing the root canal. Twenty of the 30 teeth were successfully retreated. The next most common problem was vertical root fractures (30.9%), followed by vital teeth developing periradicular lesions (19.8%). Most of the failures could have been prevented by better oral hygiene. Vertical root fractures were statistically associated with abutments in the maxilla and opposed by natural teeth; protection of these abutments with thimble crowns could prevent fractures.
Application of short-form oral health impact profile on elderly Japanese.
OBJECTIVES: The purpose of this study was to use the oral health impact profile (OHIP-14) to evaluate the impact of oral disease on the quality of life of a group of independently-living elderly persons in an urban area of Japan. SUBJECTS: A total of 1244 participants of the Senior Citizen's College, who attended the lectures once a week. They were community-dwelling, independently-living people over 60 years of age. MEASUREMENTS: Japanese version of the short-form OHIP-14. RESULTS: Internal reliability for the 14 items overall was very high (Cronbach's alpha = 0.95). Report of 'painful aching' and 'uncomfortable to eat' were the two most highly scored items using the mean sum OHIP-14 score. A multiple logistic regression analysis indicated that the sum OHIP-14 score had significant associations with self-assessment of general health, dental status, and a perceived need for dental treatment. However, age, gender, dissatisfaction with financial status or education level was not significantly associated with the sum OHIP-14. Compared with that of other countries, the items were ranked similarly, whereas the perceived magnitudes of the problems were quite different from other population. CONCLUSIONS: The OHIP-14 in Japanese had a high internal reliability, was significantly associated with dental status and comparable ranking for items when compared with studies from other countries.
Abutment tooth loss in patients with overdentures.
BACKGROUND: Since the 1960s, the use of natural teeth as overdenture abutments has become part of accepted clinical practice. Several longitudinal studies have been conducted, but tooth loss has not been reported to be a significant problem. The aim of this study was to identify the incidence and causes of tooth loss in a prospective cohort study of subjects wearing overdentures. METHODS: The study, conducted between 1973 and 1994, evaluated 273 subjects (62.3 percent male) with a mean age of 59.6 years. RESULTS: Of the 273 subjects with 666 abutments, 74 lost 133 abutments. The most common cause of tooth loss was periodontal disease (29.3 percent) followed by periapical lesions (18.8 percent) and caries (16.5 percent). Through logistic regression, the authors found that subjects who lost teeth were more likely to have medical problems that could cause soft-tissue lesions of the oral mucosa, were less likely to use fluoride daily and were less likely to return for yearly recall visits. The authors found 22 vertical fractures in 17 subjects. Chi2 analysis revealed that overdenture teeth in the maxillary arch that were opposed by natural teeth were more likely to experience vertical fractures. CONCLUSIONS: In a study that followed up some patients for as long as 22 years, the rate of tooth loss was 20.0 percent. Many of these failures could have been prevented if patients had practiced better oral hygiene. CLINICAL IMPLICATIONS: The findings suggest that if a dentist recommends overdenture therapy, the patient needs to be examined regularly to reduce the risk of experiencing caries and periodontal disease. Also, if the abutments are in the maxilla and are opposed by natural teeth, the dentist should consider using thimble crowns to reduce the risk of vertical fractures.
Dentistry for persons with special needs: how should it be recognized?
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Evaluation and characteristics of "dropouts" in a longitudinal clinical study.
This paper attempts to identify characteristics of a longitudinal clinical study's "dropout" population (1974-1996) of patients using overdentures. This study included 395 subjects. Dropouts were identified as persons who did not respond to letters or telephone calls after participating in the study for up to 2 years, could not be located, or did not wish to return to the study. Participants (N=273) and Dropouts (N=84) were compared by evaluating a series of factors: sociodemographic, medical, health, and some oral health behaviors. The population was divided into two very similar cohorts for analysis based on years of recruitment: Group I (1974-1984) and Group II (1985-1993). Significant differences were found between them, including vision problems and risk of oral soft tissue problems related to medical diagnosis. Dropouts were significantly younger than Participants, had fewer hearing and vision problems, tended to brush their teeth more often and were more likely to use daily topical fluoride in their overdentures. The differences between the Dropouts and the Participants may be that younger persons are more mobile and have fewer vision and hearing problems, but this does not help predict their commitment to a study. Health behaviors such as brushing overdenture abutments or fluoride use may be more predictable but are harder to assess until persons have been study participants for some time.
In vitro evaluation of fluoride varnish on overdenture abutments.
STATEMENT OF PROBLEM: No clinical study has evaluated the efficacy of fluoride varnish as a topical fluoride agent for the protection of overdenture abutments from dental caries. PURPOSE: This study assessed the efficacy of a fluoride varnish in protecting overdenture abutments from demineralization in an in vitro environment. MATERIAL AND METHODS: Eighty caries-free, extracted teeth were sectioned and domed immediately below the cementoenamel junction, simulating overdenture abutment preparations. Acid resistant nail varnish was painted on all surfaces except for a window (1 x 4 mm) on the prepared occlusal dentin surfaces. Teeth were randomly divided into 4 groups of 20 specimens: control, washed with deionized/distilled water; Daily Gel, treated with Karigel-N (5,000 ppm) for 4 minutes daily; Weekly Gel, treated with Karigel-N for 4 minutes weekly; and Weekly Varnish, treated with Duraflor (22,600 ppm) weekly. The varnish was removed using a blade 24 hours after each application to simulate the clinical loss of the varnish. Teeth were then placed in a cycle of demineralization (2.2 mMol/L CaCl(2)2H(2)O, 2.2 mMol/L KH(2)PO(4), and 50 mMol/L acetic acid at pH 4.3) for 6 hours and remineralization (1.5 mMol/L CaCl(2)2H(2)O, 0.9 mMol/L KH(2)PO(4), and 150 mMol/L KCl at pH 7.0 for 17 hours) for 21 days. Half the teeth in each group were brushed with no dentifrice for 10 seconds, twice daily. Teeth were sectioned at 100 +/- 10 microm buccolingually and evaluated under polarized light microscopy and contact microradiography. The depth of each lesion and the width of the remineralization bands were measured (mm). Analysis of variance models and T-tests were used to assess the effects of different treatments (alpha=.05). Duncan multiple range tests were then chosen as post hoc tests to evaluate the statistical significance of all pairwise comparisons. RESULTS: The control group had the deepest lesions (mean depth 400 +/- 39 microm). The lesions from the varnish and daily gel groups were significantly shallower than the lesions in both the control group and the weekly gel group. The remineralization bands in the varnish group were 52% wider than the control group bands. However, the daily gel group had the largest increase in band width (117% increase) compared with the control group. There were significant differences between all groups for net depth (lesion depth minus the remineralization band) (P<.0001). Daily application of fluoride gel was significantly more effective than the other treatments tested. Brushing was not a significant factor. CONCLUSION: Within the limitations of this in vitro study, treatment of overdenture abutment with various topical fluorides significantly inhibited demineralization and enhanced remineralization of cut occlusal dentin surfaces. Daily use of Karigel-N was the most effective treatment, followed by the weekly application of Duraflor varnish.
The complexities involved with managing the care of an elderly patient.
BACKGROUND: Treatment planning for and managing the care of elderly patients can be complicated for a number of reasons. To understand the patient's needs, one must understand the environment in which the patient functions. CASE DESCRIPTION: The authors present a case that illustrates some of the social, economic, financial and transportation issues that are involved in treating elderly patients, as well as how the dynamics of the interpersonal relationships influence the final treatment. CLINICAL IMPLICATIONS: A dental treatment plan can be difficult to outline to a patient because modifying factors may make care complex and difficult to manage. This requires good communication among the dentist, patient and family.
Current status of predoctoral geriatric education in U.S. dental schools.
The elderly constitute the fastest growing segment of the U.S. population. Dental schools must educate dental students so that they are competent and confident in managing the treatment needs of elderly patients. Programs in geriatric dentistry have been developed in response to the changing oral health needs of growing numbers of older adults. The purpose of this online survey was to identify the current status of predoctoral geriatric dental education in U.S. dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the World Wide Web, and fifty-four US. dental schools were invited to complete the form. Data from completed questionnaires were submitted to the investigators via email. Following repeated phone calls and emails to urge school administrators to respond to the electronic questionnaire, a 100 percent response rate was achieved. All schools reported teaching at least some aspects of geriatric dentistry, and 98 percent had curricula that contain required didactic material. Sixty-seven percent of schools reported having a clinical component to geriatric dental teaching. Of these schools, the clinical content was required in 77 percent and elective in the rest. Thirty percent of schools reported a specific geriatric dentistry clinic within the school, and 11 percent had a remote clinical site. Sixty-three percent of schools have a geriatric program director or a chairman of a geriatric section. Over a third of schools indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has continued to expand over the last twenty years and has established itself in the U.S. predoctoral dental curriculum. The format of teaching the subject varies considerably among the dental schools. Although didactic teaching of geriatric dentistry has increased markedly in the last two decades, clinical experience, both intramurally and extramurally, did not keep pace.
Utilization of dental health services by community-dwelling older adults in Japan who attended a weekly educational programme.
OBJECTIVES: The purpose of this study was to describe dental health services utilization and identify factors which influenced a group of independently living elderly persons in an urban area of Japan. SUBJECTS: The study sample consisted of 2,990 participants, 83% of the total sample of the Senior Citizen's College, who were 60 years and over. MEASUREMENTS: Their dental utilization and satisfaction with dental treatment were measured by a questionnaire from 1995 to 1998. RESULTS: The mean age of the subjects was 66.5 years and 52% were male. Sixty percent of the subjects had visited a dentist within the previous year, and 33% of them had received a regular oral health check-up. The majority of the subjects (63%) were satisfied with their dental treatment. A multiple stepwise logistic regression analysis showed that dental services utilization had a significant positive association with presence of teeth (p < 0.001), being male (p < 0.01) and satisfaction with financial status (p < 0.05). A regular oral health check-ups had a significant association with presence of teeth (p < 0.001), satisfaction with financial status (p < 0.05) and aging (p = 0.001). CONCLUSIONS: Dental health services utilization was related to the presence of teeth and financial status, rather than age or medical conditions, among independently living elderly persons in an urban area of Japan.
Association of salivary flow rate with oral function in a sample of community-dwelling older adults in Japan.
OBJECTIVE: The purpose of this study was to determine the association of stimulated salivary flow rate with perceived salivary flow and various oral symptoms among a group of independently living elderly persons. STUDY DESIGN: The subjects were 351 persons (189 men and 162 women) with a mean age of 66.7 +/- 4.3 years. Stimulated whole saliva was collected with the mastication method. Self-assessed chewing ability and satisfaction with oral function also were evaluated. A multiple logistic regression analysis was used to determine whether an independent variable was statistically significant. RESULTS: Hyposalivation (< 0.5 mL/min) was significantly associated with gender (odds ratio, 1.67; P < .05). Hyposalivation (odds ratio, 3.40; P <.05) and low perceived salivary flow (odds ratio, 5.35; P <.05) were significantly associated with dissatisfaction with tasting. Low perceived salivary flow was also significantly associated with self-assessed chewing ability (odds ratio, 3.32; P <.01). CONCLUSION: This study suggested that hyposalivation and low perceived salivary flow were related to chewing ability and satisfaction with tasting foods.
"There is nothing wrong with my teeth." What is informed consent for persons with cognitive impairment?
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Dental status and satisfaction with oral function in a sample of community-dwelling elderly people in Japan.
The purpose of this study was to determine the influence of dental status on oral function and satisfaction among a group of independently living elderly persons in an urban area of Japan. The study sample consisted of participants of the Senior Citizens' College from 1995 to 1999. Their dental status and oral satisfaction were measured by a questionnaire. The number of usable questionnaires was 3967, or 80.8% of the total sample. The mean age of the subjects was 66.5+/-4.3 years, and 52.2% were male. Twenty-nine percent of them had a natural dentition, and 7.0% were edentulous in both jaws. The prevalence of edentulism in the study sample was significantly lower (p < 0.01) than that for the national survey. Overall, 66.4% of the subjects were satisfied with their ability to chew, 56.2% with the appearance of their teeth, 63.1% with their ability to speak clearly, and 76.5% with their ability to taste food. For complete-denture wearers, the greatest dissatisfaction was with speech (28.5%); however, for the RPD wearers, it was with chewing ability (21.7%). Sixty-one percent of complete-denture wearers reported that they were satisfied with their chewing ability, but only 11% of them could eat all three of the evaluated foods without difficulty. The multiple stepwise logistic regression analyses showed that both dental status and self-assessed general health had a significant association with dissatisfaction with all four oral functions and self-assessed impairment of chewing ability. There were significant associations between the elderly subjects' dental status and oral function.