Gulcan Coskun Akar

Systemic Consequences of Poor Oral Health in Chronic Kidney Disease Patients

Changes in the oral cavity, such as periodontitis and other manifestations of poor oral health, are common in patients with chronic kidney disease (CKD) and may contribute to increased morbidity and mortality because of systemic consequences such as inflammation, infections, protein-energy wasting, and atherosclerotic complications. Poor oral health in CKD patients may thus represent an important, but often overlooked, problem. Several studies show that uremic patients have higher rates of decayed, missing, and filled teeth, loss of attachment, and periapical and mucosal lesions than the general population. The consequences of poor oral health may be more severe in CKD patients because of advanced age, common comorbidities such as diabetes, concurrent medications, and a state of immune dysfunction that may increase the risk for systemic consequences of periodontitis and other oral and dental pathologic conditions. Poor dentition and other signs of poor oral health should be an alarm clock also at early stages of CKD. However, it remains to be determined whether more successful management of poor oral health and periodontitis will reduce the risk of inflammation, infection, protein-energy wasting, and atherosclerotic complications in CKD patients. This review explores etiological factors and potential systemic consequences of poor oral health in CKD patients as well as possible preventive and therapeutic strategies.

The oral hygiene and denture status among residential home residents

The aim of this study was to investigate the oral hygiene practices and denture status of elderly people living in a residential home. One hundred one elderly people living in Gurcesme Zubeyde Hanim Residential Home, Izmir—52 women (mean age 75.5 ± 7.8) and 49 men (mean age 75.3 ± 8.8)—participated in an interview. Their oral hygiene practices, self-perceived oral health, denture status, and needs of denture were noted down. Self-perceived oral health was very bad in 9.9%, bad in 47.5%, good in 33.7%, and very good in 8.9%. From 69 people who reported maintaining oral hygiene, the incidence of oral hygiene practice was 36.2% once a day, 31.9% three times a day, 21.8% once a week, and 10.1% seldom. The majority, 60 people (59.4%), were dentate. Among the dentate, 47 people (78.3%) had full denture, 4 (6.6%) removable partial denture, 2 (3.3%) fixed/removable partial denture, 5 (8.3%) full/removable partial denture, and 2 (3.3%) one or more fixed partial dentures. By gender, 57.6% female and 61.2% male subjects were dentate. The relationship between having a social security and having a denture was significant (p = 0.02); having a denture and needing a denture was also significantly related (p = 0.00). The high prevalence of needs for denture pointed to the requirement for frequent dental check ups. The most important need within the residents of the residential home was daily oral hygiene. Nurses trained on this subject are required.

Effects of surface-finishing protocols on the roughness, color change, and translucency of different ceramic systems.

STATEMENT OF PROBLEM Surface-finishing protocols have a mechanical impact on ceramic surfaces that could eventually affect surface topography and light scattering. An optimum protocol is needed to avoid damaging the optical properties of ceramics. PURPOSE The purpose of this study was to determine the effects of different surface-finishing protocols on the surface roughness, color change, and translucency of ceramic and metal ceramic restorations. MATERIAL AND METHODS Standardized disk-shaped specimens (1.5 × 10 mm, n=128) were fabricated from 3 different ceramic core materials (aluminum oxide [Al2O3]-AL, zirconium oxide [ZrO2]-ZR, lithium disilicate [Li2Si2O5]-LIT), veneered (V) with dentin ceramics (n=32 per group), and placed in the following groups: ALV, ZRV, and LITV. The metal ceramic group acted as the control (n=32). Four different surface-finishing methods were tested. Airborne-particle abrasion with 50 μm Al2O3, polishing with adjustment kit, polishing with adjustment kit plus diamond polishing paste, and autoglazing (n=8 subgroup) were applied on the veneering ceramics. The specimens were analyzed with a profilometer for surface roughness, and color change and translucency were measured with a clinical spectrophotometer. Statistical analyses were performed with 1-way ANOVA and the Tukey honest significant difference tests (α=.05). RESULTS Specimens treated with the airborne particle abrasion method showed significantly higher mean profilometer for surface roughness values in all groups (P<.05). The polishing with adjustment kit and autoglazing methods revealed statistically similar surface roughness values in all groups (P>.05). With the diamond polishing paste method, lower surface roughness values were achieved in the ZRV and metal ceramic groups acted as the control groups. Different surface-finishing methods affected the color change of the ceramic systems, except for ZRV. Surface-finishing protocols significantly affected the translucency values of the ALV, LITV, and metal ceramic groups (P<.05). CONCLUSIONS No single surface-finishing protocol can be recommended to obtain the smoothest surface and the least color change without affecting translucency for the ceramics tested. The airborne-particle abrasion protocol created rougher surfaces and decreased translucency, and color change in zirconia was not affected by the finishing protocols.

Reliability and Validity of the Geriatric Oral Health Assessment Index in Turkey

The purpose of this study was to test the reliability and validity of the Turkish version of the Geriatric Oral Health Assessment Index (GOHAI). Data were obtained from a cross-sectional survey of 101 older adults living at a residential home in the Izmir municipality of Turkey. The Turkish version of the GOHAI showed acceptable reliability and validity. The Cronbachs alpha coefficient was 0.75, and item-scale (Pearsons) correlations varied between 0.30 and 0.67. Low GOHAI scores were associated with perceived poor oral health (p < 0.01) and dissatisfaction with oral health status (p < 0.05). Factor analyses of the index indicated a two-factor solution. It was concluded that the Turkish version of the GOHAI is a reliable and valid measure for use with Turkish adults age 65 and older.

Examination of the heads of the lateral pterygoid muscle on the temporomandibular joint.

The lateral pterygoid muscles (LPMs) function as a unit during precise mandibular positioning movements that occur during such activities as speech, singing, or playing musical instruments. The LPM has been the focus of an attempt to explain problems associated with the temporomandibular joint and anterior displacement of the meniscus of the joint. The aim of the study was to define the general morphology, describing the position and shape of the heads of the LPMs. In the course of dissection, the heads of the LPMs were noted, as well as the pattern, position of the origin and insertion, and course under 2.5× loupe magnification in 25 adult male human cadavers. The LPM has the general form of an irregular pyramid that narrows progressively toward the front. As a result of the macroscopic examination, the LPM was found to originate, with 3 heads as the superior LPM (SLPM), the inferior LPM (ILPM), and inner LPM. It was realized that the ILPM width was 3 times more than that of the SLPM. The SLPM ending fibers of LPM had a more tendinous structure compared with the ILPM ending fibers. The SLPM and ILPM were observed as being adhered mostly to the pterygoid fovea. The study has shown that the muscle has atypical penniform structure made up of 8 tendinous layers that were particularly well developed. It is an indisputable fact that the success in surgical strategy and planning mainly relies on the surgeons knowledge of the variable origins and insertions of the LPM.

Malnutrition due to bisphosphonate-related osteonecrosis of the jaw in a chronic dialysis patient: case report

Abstract Adequate nutrition is imperative for a successful outcome in dialysis patients. Excellent oral hygiene and an efficient mastication can help to correct several metabolic and endocrine disturbances as well as delay initiation of dialysis in patients with chronic renal failure. However, concerns exist about the risk of malnutrition and protein depletion. On the other hand, intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. This complication occurs either spontaneously or after minor dento-alveolar surgery including extraction of teeth. A malnourished dialysis patient who showed the typical clinical features of bisphosphonate-related osteonecrosis of the jaw (BRONJ) without any obvious radiological changes in his panoramic radiograph is reported. To minimize the risk of BRONJ, patients initiated on bisphosphonates should optimize routine dental care and have their baseline oral health evaluated by both clinical and radiographic examinations before initiation of bisphosphonate therapy.

Characterıstics of Mandibular Incisive canal and Lingual foramen Using Dental Volumetric Tomography (DVT)

OBJECTIVE: To investigate the presence, location and the dimensions of incisive canal and lingual foramen using dental volumetric tomography (DVT). METHODS: Thirty-one dry human mandibles were exposed using a DVT system. Images were examined for the presence of mandibular incisive canal (MIC) and lingual foramina (LF) including their dimensions and anterior-posterior lengths. In addition; labial and lingual diameters and heights of LF was determined. LF were classified with respect to the mental spine as well. RESULTS: MIC was observed in 58% of the images with mean diameter of 2.79mm while the mean length was 2.88mm. Total of 60 LF were observed in 31 mandibles. Twenty eight (47%) of them were located superior while 32 (53%) were located inferior to the genial spines. Only one canal was observed in 30% of the LFs whereas 50% of LFs had two and 20% had three canals. The mean lingual and labial diameters of the LF canals were 0.68mm and 0.63mm respectively. The mean height was 10.57mm and 9.53mm at the lingual and labial sides. CONCLUSION: The MIC, LF and associated neurovascular bundles may show many variations in number, location and size. Therefore, particular evaluation of these structures for each case is recommended.