Giselle Rodrigues Ribeiro

Oral health of the elderly with Alzheimer's disease

OBJECTIVE The objective of this study was to describe the oral health of elderly people diagnosed with Alzheimers disease (AD). STUDY DESIGN Thirty elderly subjects with AD (mild, moderate, and severe) and 30 without AD (controls) were included in the study. Volunteer-reported oral health data were collected using the General Oral Health Assessment Index (GOHAI). Demographic and oral characteristics were assessed, including the number of natural teeth; number of decayed, missing, and filled teeth (DMTF); oral health index (OHI); removable prosthesis conditions; and oral pathologies. RESULTS GOHAI values were similar for both groups. Compared with the controls, the subjects with AD had a higher age, DMTF, OHI, and number of oral pathologies and a lower educational level and number of natural teeth. CONCLUSIONS Elderly subjects with AD had poorer oral health than those without the disease. Despite the positive self-perception of their oral health, the oral health of subjects with AD tended to decline as their disease progressed.

Mandibular movements and bite force in Alzheimer's disease before and after new denture insertion

Chewing impairment has been observed in elders with Alzheimers disease (AD); however, it is unknown whether oral rehabilitation can improve their masticatory function. This study evaluated the influence of new removable prostheses on chewing function of patients with AD. Participants using removable dentures were divided into two groups: patients with mild AD (77·2 ± 5·8 years, n = 16) and controls (76·0 ± 4·4, n = 16). All participants received general dental treatment and new total and/or partial removable prostheses. After 2 months of adaptation to the new dentures, chewing was evaluated by the following parameters: masticatory cycle time (CT), cycle velocity (CV), and opening (OA) and closing mandibular angles (CA), registered by a kinesiographic device. Maximum bite force (MBF) was assessed using a strain sensor. Evaluations were performed at baseline and after insertion of the new prostheses. A mixed model (α = 5%) was used for within- and between-subject analyses. After insertion of new prostheses, CT was reduced, and CV and MBF were increased in both groups (P < 0·05). There were no changes in OA or CA (P > 0·05). Compared to controls, elders with AD showed higher CT and reduced MBF and CV both at baseline and after insertion of new prostheses (P < 0·05). However, OA and CA did not differ between groups (P > 0·05). Insertion of new removable prostheses improved masticatory function in elders with and without AD, but patients with mild AD still had reduced chewing parameters compared to controls.

Oral Health in Elders with Parkinson's Disease

This study aimed to evaluate objectively and subjectively the oral health of elders with Parkinsons disease (PD), using clinical oral assessments and the General Oral Health Assessment Index (GOHAI). Subjects included 37 removable prosthesis wearers, 17 with PD (mean age 69.59±5.09 years) and 20 without PD (mean age 72.00±5.69 years). The objective assessment included an evaluation of oral characteristics, including the number of remaining teeth, decayed, missing and filled teeth (DMFT), visible plaque index (VPI), salivary flow rate and removable prosthesis conditions. The subjective assessment included self-perception of oral health collected using the GOHAI index. The number of remaining teeth, DMFT, VPI, salivary flow rate and GOHAI data were compared between the groups using t-tests. Removable prosthesis conditions were analyzed using χ2 tests (p<0.05). There were no group differences in the number of remaining teeth, DMFT, VPI or salivary flow rate (p>0.05). Greater maxillary prosthesis defects were observed in the control group (p=0.037). GOHAI scores were low for the PD group and moderate for controls, yielding a group difference (p=0.04). In conclusion, elders with PD have similar oral health to controls. Although all elders had few remaining teeth, high DMFT and high VPI, PD elders had more negative self-perceptions of their oral health than did the controls.

Mastication and oral health–related quality of life in removable denture wearers with Alzheimer disease

Statement of problem. Alzheimer disease (AD) can affect masticatory function, affecting oral health–related quality of life (OHRQoL). Whether oral rehabilitation with conventional removable prostheses can restore masticatory function and improve OHRQoL in these individuals is unknown. Purpose. The purpose of this clinical study was to evaluate the influence of oral rehabilitation with removable prostheses on masticatory efficiency and OHRQoL in elders with and without AD. Material and methods. Thirty‐two elders with mild AD (n=16, mean age=76.7 ±6.3 years) or without AD (n=16, mean age=75.2 ±4.4 years) were recruited. All participants first underwent masticatory efficiency and OHRQoL evaluations, and 2 months after insertion of new removable prostheses, the variables were reassessed. Masticatory efficiency was determined using the sieving method, and OHRQoL was measured by applying the Geriatric Oral Health Assessment Index (GOHAI). The data from the baseline and after insertion of the new removable prostheses were compared by paired t test. Group differences at each time point were assessed by t test (&agr;=.05). Results. After insertion of the new removable prostheses, masticatory efficiency and OHRQoL improved in both the elders with AD and the control. At baseline, elders with AD had lower masticatory efficiency and higher OHRQoL than controls (P<.05). After removable prosthesis insertion, elders with AD continued to show lower masticatory efficiency values than controls, but their OHRQoL was similar. Conclusions. Oral rehabilitation with new removable prostheses improved the masticatory efficiency and OHRQoL of elders with and without AD, although masticatory efficiency did not reach control levels in elders with AD.

Influence of a removable prosthesis on oral health-related quality of life and mastication in elders with Parkinson disease

Statement of problem Parkinson disease (PD) symptoms, such as muscle rigidity, tremors in the lips and tongue, and involuntary mandibular movements, may cause oral health‐related problems, mastication difficulties, and denture discomfort because of the difficulty in controlling a prosthesis with the oral musculature. Purpose The purpose of this observational clinical study was to evaluate the influence of oral rehabilitation with a removable prosthesis on oral health‐related quality of life (OHRQoL) and masticatory efficiency (ME) in elders with PD. Material and methods Thirty‐four elders with PD (n=17, mean age 69.4 ±4.7 years) or without PD (n=17, mean age 70.7 ±4.7 years) were recruited. All participants first underwent OHRQoL and ME evaluations. Two months after the insertion of new removable prostheses, the participants were reassessed. The OHRQoL was measured with the Oral Health Impact Profile (OHIP‐49). ME was evaluated by determining the percentage weight of the comminuted silicone‐based artificial material that passed through a 2.8 mm sieve. For each group, data were compared between baseline and after insertion of new removable prostheses by paired t test or Wilcoxon sign test/signed‐rank test. Group differences were assessed at each time point by t test (&agr;=.05). Results After the insertion of removable prostheses, elders with PD showed improved OHRQoL and ME. Controls also showed improvements on both measures after insertion of removable prostheses. At baseline, elders with PD had lower OHRQoL and ME compared with the controls (P<.05). After removable prosthesis insertion, the elders with PD continued to show lower ME values than the controls, but their OHRQoL was similar. Conclusions Oral rehabilitation with new removable dental prostheses improved the OHRQoL and ME in elders with and without PD, although ME did not reach control levels in elders with PD.

Removable prosthesis hygiene in elders with Parkinson's disease: PROSTHESIS HYGIENE IN PARKINSON'S DISEASE

AIM To evaluate changes in prosthesis hygiene in elders with Parkinsons disease (PD) in response to verbal instruction and positive reinforcement. METHODS AND RESULTS Elders with removable prostheses were divided into PD (n = 17) and control (n = 20) groups. Biofilm on prostheses was measured at baseline, and verbal instructions on prosthesis hygiene were given. After 7, 14, and 30 days, biofilm presence was re-evaluated and the results were shown to participants, with repeated cleaning instruction. At baseline, participants with PD had more biofilm on maxillary prostheses than did controls (p = 0.009). At 30 days, biofilm presence on maxillary and mandibular prostheses did not differ between groups. Both groups showed reductions in biofilm accumulation on prostheses over time, but this effect took longer to appear on mandibular prostheses in the PD group (p < 0.05). CONCLUSION Verbal instruction and positive reinforcement can improve prosthesis hygiene in elders with and without PD.

Conventional Complete Denture in Patients with Ectodermal Dysplasia

Ectodermal dysplasia is described as heritable conditions that involve anomalies of structures derived from the ectoderm, including hypodontia. In the cases of edentulous young patients, who did not finish their craniofacial growth, treatment with conventional complete denture is a suitable alternative. The aim of this study was to report a case of mandibular edentulism treated with conventional complete denture in a thirteen-year-old patient diagnosed with hidrotic ectodermal dysplasia. Typical features, such as frontal bossing, depressed nasal bridge, protuberant lips, scarce hair, and brittle nails, were visualized during the extraoral examination. The intraoral inspection and radiographic analysis revealed oligodontia, dental malformation, and prolonged retention of deciduous teeth at maxilla and total edentulism at mandible. A conventional complete denture was planned and constructed following the same steps of technique as recommended in adults. Although this option is not a definitive treatment, the patient and his parents were satisfied with his improvement in chewing and speech, as well as with the aesthetic benefits.