Anastassia Kossioni

European College of Gerodontology: undergraduate curriculum guidelines in Gerodontology

Effective undergraduate teaching of gerodontology to present and future dental students is important if good oral health care of older people is to be assured. A review of the undergraduate curriculum for gerodontology is presented and indicates the need for a knowledge base from which new graduates can develop a special interest in care of older patients. The aim is improved care of older patients, satisfaction for teaching staff involved and improved professional standing for Dentistry. Motivation of students could also be achieved by the positive match between rising patient awareness and ethical responsibility of the profession for those older patients. As it stands, the undergraduate curriculum should include topics on specific care for the elderly and other patient groups, which extend the competences already agreed by the Association for Dental Education in Europe (ADEE). The logistics of teaching these topics will need co-ordination of those staff with appropriate skill and interest, preferably as a development of existing curriculum content.

The prevalence of denture stomatitis and its predisposing conditions in an older Greek population

BACKGROUND Pathology related to complete denture-wearing will remain an important issue because of an increase in the ageing population. OBJECTIVE To investigate the prevalence and the risk factors for denture-related stomatitis in the edentulous maxilla of older patients with a maxillary complete denture. MATERIAL AND METHODS One hundred and six patients treated in the Department of Prosthodontics of the Athens Dental School were interviewed and clinically examined. The results were analysed using chi-square tests and multiple logistic regression. RESULTS Denture stomatitis was recorded in 39.6% of the sample (pinpoint hyperaemia: 17%, diffuse erythema: 16%, papillary hyperplasia: 6.6%). Chi-square tests recorded significant associations between denture stomatitis and the continuous use of dentures (particularly the diffuse erythema type), the increased duration of denture experience and the poor retention of the maxillary denture. Other significant associations were recorded between the increased age of the current denture and pinpoint hyperaemia, and the reduced frequency of denture cleaning and papillary hyperplasia. Multiple logistic analysis revealed that the most important risk factor for denture stomatitis was the continuous use of the denture. CONCLUSION The prevalence of denture stomatitis was high in denture users. Although many predisposing conditions were recorded, the most important risk factor was the continuous use of the denture. Therefore, appropriate advice on denture maintenance should be provided.

The stomatognathic system in the elderly. Useful information for the medical practitioner

Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class). Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene) have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.

Is Europe prepared to meet the oral health needs of older people

OBJECTIVE To discuss the preparedness of the social and health care systems and the health workforce in Europe to manage the increasing general and oral health care needs of older adults. BACKGROUND AND DISCUSSION There are large inequalities across European countries and regions in the demographic, socioeconomic and health status of the elderly. The ageing of the population and the economic crisis put at risk the existing social and health care systems and are expected to further widen the existing inequalities. Despite the increase in funding for the general health care, public funding for dental care has reduced, limiting the access for the disadvantaged elderly. Dental care is isolated from health care policies and funding. At the same time there is a significant shortage of adequately trained personnel in the care of the elderly and a shortage of training opportunities particularly at a postgraduate and continuing education level. CONCLUSION Immediate action is needed and appropriate strategies need to be implemented. Oral health prevention, delivery policies and funding should be integrated within the general health care system. Clinical protocols and guidelines need to be developed on the oral care of the elderly. Interdisciplinary training in the care of the elderly needs to be implemented for all health care workers (dentists, physicians, nurses, health care aids, social workers) at all education levels to enhance comprehensive care.

Variation in the masseteric silent period in older dentate humans and in denture wearers

The masseteric silent period was elicited by chin taps at 40% clenching in the masseter muscle of the preferred chewing side in 22 younger dentate individuals, in 22 older dentate individuals, in 22 older experienced denture wearers and in 7 older inexperienced denture wearers. One simple and three combined types of silent period (combination of early and late phases of depression) were recorded in all groups. An early silent period was always elicited, the only exception being in some inexperienced denture wearers. Both the age and the extent of rehabilitation with dentures in the trained denture wearers affected reflex latencies (p < 0.05), while the variation in duration was not significant (p > 0.05). The duration of the silent period was, however, affected by the type of silent period, thus by the measuring technique (p < 0.05). Increased variation was observed in the inexperienced denture wearers, who were in a period of adaptation.

Reproducibility of the human masseteric jaw-jerk reflex in association with the menstrual cycle

The jaw jerk was elicited by chin taps in the relaxed masseter muscle of the preferred chewing side in five young females. Recordings were made during three randomized sessions and under standardized conditions: two sessions between the seventh and the 15th day of the female menstrual cycle and the third within the last 5 days of the cycle. Both latency and duration of the reflex were generally reproducible over time. Individual between-session variation was occasionally present, with a general tendency for lower values in the end-cycle session, but this did not affect the overall results. Systematic subject variation, such as central excitatory-state variance of the timing of the experiments, and possibly some other uncontrolled technical error, may have contributed to the observed variation.

Random variation in the masseteric silent period after chin taps

Although the silent period duration has often been evaluated as a potential indicator of stomatognathic system dysfunction, there is still some uncertainty as to its normal biologic variation. This study investigated the subject variation in the silent period in a group of 22 young and healthy subjects under standardized conditions. Electromyographic recordings were obtained from the masseter muscle at 40% clenching after chin taps. Four different patterns of the silent period were recorded: one simple and three combined. Although the latencies of the early and late phases of depression were generally consistent, the results for duration were more variable and depended on the pattern of the silent period.

Self-reported oral complaints in older mentally ill patients

Aim:  The aim of this study was to investigate the prevalence of self‐reported oral complaints in older hospitalized mentally ill patients and relate them to the primary psychiatric diagnosis.

Guidelines for the organisation of continuing professional development activities for the European dentist.

AIM Free movement of dental professionals across the European Union calls for more uniform continuing education in dentistry to ensure up-to-date, high-quality patient care and patient safety. This article provides guidelines for the management and delivery of high-quality continuing professional development (CPD) by European dental schools and other CPD providers. METHOD The guidelines are based on an extensive literature inventory, a survey of existing practices (both available as separate publications), discussions during meetings of the Association for Dental Education in Europe in 2011 and 2012 and debate amongst the members of the DentCPD project team representing six dental schools. RESULTS On the basis of the literature review, survey and discussions, we recommend that (i) every dentist should be given the opportunity for CPD, (ii) providers should be quality-approved and impartial, (iii) educators should be approved, impartial, suitably trained, and with educational expertise, (iv) the mode of CPD delivery should suit the educational activity, with clear learning objectives or outcomes, (v) effort should be made to assess the learning, (vi) participant feedback should be collected and analysed to inform future developments and (vii) uniform use of the pan-European system of learning credit points (ECTS) should be implemented. CONCLUSION Implementation of these guidelines should make dental CPD more transparent to all relevant parties and facilitate the transferability of earned credits across the European Union. It will also enable better quality control within dentistry, resulting in enhanced dental care and ultimately the improvement in patient safety.

The effect of intercuspal clenching on the masseteric jaw-jerk reflex in humans.

Although several studies have been conducted regarding the jaw-jerk reflex and its various modifying parameters, the effect of intercuspal clenching still remains poorly understood. Evidence of both excitatory and inhibitory influences of periodontal receptors on jaw muscle activity has been reported. It is also suggested that a level of background activity in the stimulated muscle facilitates the reflex response. It was therefore the purpose of this study to investigate the effect of simultaneously activated periodontal receptors on the various parameters of the masseteric jaw-jerk reflex during moderate masseter muscle activation. Electromyographic recordings were obtained from the masseter muscle of the preferred chewing side at rest and at intercuspal clenching in 10 men, by use of a computerized recording and analysis system. In the clenching trials the level of muscular activity was set at 40% of the maximum value obtained through visual feedback. The results showed that at 40% clenching the occurrence of the reflex was reduced as compared with that obtained at rest. Moreover, when present during clenching, its latency and duration were shorter, whereas its amplitude was higher. It was suggested that the simultaneous activation of periodontal receptors may occasionally inhibit the masseteric monosynaptic excitation.