Ejvind Budtz-Jorgensen

Candida-associated denture stomatitis in type 2 diabetes mellitus.

OBJECTIVE To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements. MATERIALS AND METHODS Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects. RESULTS Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001). CONCLUSIONS Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Alternate framework designs for removable partial dentures

STATEMENT OF PROBLEM The removable partial denture is usually less appreciated than the fixed partial denture by both patients and prosthodontists. This negative attitude could be due to problems associated with the wearing of a removable partial denture and concern essentially with comfort, esthetics, masticatory function, occlusal stability, and maintenance of oral hygiene. Such problems could be limited if treatment planning is made carefully, according to simplified and logical principles for framework design, and if oral hygiene and the fit of the dentures are regularly controlled. PURPOSE This article reviews the factors associated with the prognosis of treatment with removable partial dentures. Furthermore, the article describes framework design applied in different clinical situations and compares them with more conventional designs. It seems important to consider a framework design that privileges comfort, esthetics, and oral hygiene rather than to follow mechanical rules that are entirely theoretical and have not been confirmed scientifically or clinically.

Caries prevalence and associated predisposing conditions in recently hospitalized elderly persons

The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender. Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.

Caries, Tooth Loss, and Conventional Tooth Replacement for Older Patients

During the recent decades, industrialized countries have shown an important decline in edentulism and a corresponding increase in the mean number of teeth present among elderly people (Atchieson & Andersen, 2000; Morse, Holm-Pedersen, & Holm-Pedersen, 2002). However, studies still show rather large populations of older with few or no teeth (Kiyak, 2000; Avlund, Holm-Pedersen, & Schroll, 2001). This implies that prevention of oral health problems should be aimed at the growing number of older adults at risk of oral diseases and that caries therapy and prosthetic therapies should be considered and implemented in order to maintain and restore oral function and aesthetics. Because any restorative caries or prosthetic therapies have a short-term or long-term biologic price, such therapies should only be implemented when there is clear evidence that function or aesthetics is invalidated. When considering the indications for prosthetic therapy and the choice of treatment modality, professional considerations as well as the patient’s demand and socio-economic situation are key factors. However, treatment planning for the medically compromised or dependent geriatric patient is even more complex, as it also includes an assessment of the patient’s general physical and cognitive state and the patient’s perceived need for prosthetic treatment as well as the realistic need (Vigild, 1989). The latter is based on a professional assessment of the normative need, the perceived need, and the expressed demand for treatment, taking into account the general mental and physical state of each individual. Finally, dental and prosthodontic treatment planning is dependent on the allocation of resources, and hence is a political decision. Socio-economic factors are particularly important in the prosthetic treatment of older patients because restricted financial means often limits the possibilities to very simple treatments, such as treatment with conventional complete dentures (Mojon, Thomason, & Walls, 2004; Palmqvist, Soderfeldt, & Vigild, 2001).