A.W.G. Walls

The Relationship among Dental Status, Nutrient Intake, and Nutritional Status in Older People

Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.

The relationship between oral health and nutrition in older people

The oral health of older people is changing with reducing numbers of people relying on complete dentures for function, and retaining some natural teeth. Despite this there are substantial numbers of older people whose ability to chew foods is compromised by their oral health status, either because they have few or no natural teeth. This alteration results in individuals selecting a diet that they can chew in comfort. Such diets are low in fruits and vegetables intake with associated reduction in both non-starch polysaccharide and micronutrient intakes. There is also a trend for reduced dietary intake overall. Salivary flow and function may have an impact in relation to the ability to chew and swallow. Whilst there are few differences in salivary function in fit healthy unmedicated subjects, disease resulting in reduced salivary flow and particularly polypharmacy, with xerostomia as a side effect, are likely to have a role in older people. This paper explores the relationships between oral health status and foods choice and discusses the potential consequences for the individual of such dietary change.

The relationship between oral health status and Body Mass index among older people: a national survey of older people in Great Britain

Aims To assess the relationship between oral health status and Body Mass Index.Material and methods This paper relates to the free-living sample (participants who lived in their own home, rather than an institution) of the National Diet and Nutrition Survey: people aged 65 years and older.Subjects 629 adults.Data collection A probability random national sample of adults who had a dental examination, an interview and an anthropometric examination.Data analysis Fishers exact test and multivariate logistic modeling.Findings Being underweight was relatively uncommon in this population. People without teeth were significantly (P=0.05) more likely to be underweight than those with 11 or more teeth; 12.3% and 2.9%. A highly statistically significant (P=0.001) difference was observed in BMI between dentate people with 1-10 teeth and with more than 10 teeth; 24% and 2.9% were underweight. Dentate people with less than 21 natural teeth were on average more than 3 times more likely to be obese than those with 21-32 teeth (P=0.036). There was no significant difference in both the proportion of overweight and obese adults between those who were edentulous and dentate with 21 or more teeth. A similar pattern was observed when the number of posterior occluding pairs was compared with BMI categories. Results of multiple logistic regression were adjusted for the confounding effects of age, social class, region of origin and partial denture wearing.Conclusions Older people in Britain with more than 20 teeth are more likely to have a normal Body Mass Index.

Glass polyalkenoate (glass-ionomer) cements: a review

Abstract This paper reviews the history and development of glass polyalkenoate (glass-ionomer) cements from their inception at the Laboratory of the Government Chemist during the 1960s to the present day.

The effect of storage media upon the surface microhardness and abrasion resistance of three composites

The effects of various storage media [distilled water, lactate (pH 4.0), and citrate (pH 6.0) buffers] upon the hardness and wear factor values of three composites [Occlusin (O), P-30 (P), and Fulfil (F)] were studied. Over the one-year storage period, the hardness of all three materials stored in citrate buffer was unchanged. In the case of P in water and all materials stored in lactate buffer, a reduction was observed. There was no significant difference (P greater than 0.05) between the wear factors of specimens after one year or one week of water storage. Specimens of F stored in citrate buffer had a wear factor (P less than 0.01) higher than that of those stored in water. The other materials were not affected by storage in the lactate or citrate buffers. A reduction in surface hardness for some materials did not result in an increase in wear rate. This indicates that the softening effect was limited to a thin surface layer. Although not significant in vitro, this effect would probably increase the rate of in vivo wear, since the softened material would be lost, exposing a fresh surface to further attack. This would adversely prejudice the materials long-term clinical durability by impairing its resistance to abrasion.

Nutrition Counseling Increases Fruit and Vegetable Intake in the Edentulous

Edentulous denture-wearers eat fewer fruits and vegetables than do comparable dentate individuals. Improved chewing ability with new dentures has resulted in little dietary improvement, suggesting that dietary intervention is necessary. The objective of this randomized controlled trial was to have a positive impact upon dietary behavior of patients receiving replacement complete dentures through a tailored dietary intervention. Readiness to change diet (Stage of Change), intake of fruits, vegetables, and nutrients, and chewing ability were assessed pre-and 6 weeks post-intervention. The intervention group (n = 30) received two dietary counseling sessions; the control group (n = 28) received current standard care. Perceived chewing ability significantly increased in both groups. There was significantly more movement from pre-action into action Stages of Change in the intervention group, who had a greater increase in fruit/vegetable consumption (+209 g/d) than did the control group (+26 g/d) (P = 0.001). Tailored dietary intervention contemporaneous with replacement dentures can positively change dietary behavior.

Major clinical findings from a dental survey of elderly people in three different English communities

A random sample of 2280 subjects aged 60 years or over from three areas of England were examined clinically in order to assess their dental health and needs. Between 33% (south of England) and 57% (north of England) were edentulous. Twenty per cent of all dentate subjects were edentulous in one arch and thus still required a complete denture. Amongst the dentate subjects geographical differences were small, but social class and behavioural differences were large. Dental non-attenders were the group who stood out as having much poorer oral health, averaging six fewer natural teeth than attenders. Nearly 50% of all teeth either had coronal fillings or needed them. Root caries was common, 20-22% of vulnerable teeth were affected and there was an age related increase in disease risk. The mean number of teeth with decayed roots per subject (0.8) was similar to the mean number with decayed coronal surfaces (0.9). Moderate tooth wear and moderate periodontal disease were both widespread. A minority of subjects had a functional dentition of 21 or more teeth. Major changes in the dental status of older adults have taken place in the last 30 years and these will continue, resulting in lower levels of edentulousness but a large need for maintenance of existing restorations

Wear characteristics in a two-body wear test.

OBJECTIVES A previous report compared spherical steatite (ceramic enamel substitute) abraders with those of natural enamel in a two-body wear test. The wear rates and coefficients of friction of the two abraders against various composites and an amalgam were well correlated although the wear rates were slightly higher with steatite. This report investigates the characteristics of the worn abrader and specimen surfaces. METHODS Scanning electron microscopy and laser profilometry were used. RESULTS Similar wear characteristics were found for the two types of abraders. Adhesive wear was evident for the amalgam, Dispersalloy (Johnson & Johnson), and the heat/pressure-cured microfill composite, Isosit (Ivoclar-Vivadent). Abrasion was seen with the hybrid composite, Occlusin (ICI), and, to a lesser extent, the microfill composite, Heliomolar (Ivoclar-Vivadent). The appearance of the worn small particle hybrid composite, Brilliant Dentin (Coltène), suggested that fatigue and delamination were involved. Laser profilometry showed that the hybrid composites caused much greater wear to the abraders than either the microfill composites or amalgam. The Ra values of the worn abraders and specimens were similar, suggesting conformal contact between them and endorsing the well controlled conditions of the wear test. SIGNIFICANCE The results of this and other publications suggest that steatite can be used as an alternative to enamel in performing two-body wear tests on dental composites. This should help significantly in materials evaluation and development.

Association of removable partial denture use with oral and systemic health

OBJECTIVES This narrative literature review aims to consider the impact of removable partial dentures (RPDs) on oral and systemic health. DATA AND SOURCES A review of the literature was performed using Medline/PubMed database resources up to July 2011 to identify appropriate articles that addressed the objectives of this review. This was followed by extensive hand searching using reference lists from relevant articles. CONCLUSIONS The proportion of partially dentate adults who wear RPDs is increasing in many populations. A major public health challenge is to plan oral healthcare for this group of patients in whom avoidance of further tooth loss is of particular importance. RPDs have the potential to negatively impact on different aspects of oral health. There is clear evidence that RPDs increase plaque and gingivitis. However, RPDs have not clearly been shown to increase the risk for periodontitis. The risk for caries, particularly root caries, appears to be higher in wearers of RPDs. Regular recall is therefore essential to minimise the risk for dental caries, as well as periodontitis. There is no evidence to support a negative impact on nutritional status, though research in this area is particularly deficient. Furthermore, there are very few studies that have investigated whether RPDs have any impact on general health. From the limited literature available, it appears that RPDs can possibly improve quality of life, and this is relevant in the era of patient-centred care. Overall, further research is required to investigate the impact of RPDs on all aspects of oral and general health, nutritional status and quality of life.

The polymerization contraction of visible-light activated composite resins

Abstract The polymerization contraction of a number of commercially available composite resin restorative materials has been determined using a minimal load transducer to monitor dimensional change. The putative posterior composite materials underwent least contraction during setting, and there was moderate correlation between polymerization contraction and both the exotherm on polymerization and the filler loading (for non-microfine materials). Polymerization contraction was influenced by the shade of the material under test and the duration of the exposure to the activating light source.