Lin-Yang Chi

Outcomes of oral squamous cell carcinoma in Taiwan after surgical therapy: factors affecting survival.

PURPOSE The study goal was to determine which clinical features correlated with 5-year survival in patients surgically treated for oral squamous cell carcinoma (OSCC) in Taiwan. PATIENTS AND METHODS The records of 378 OSCC patients surgically treated with or without chemotherapy and radiotherapy were reviewed retrospectively. Their 5-year survival in relation to age, gender, tumor site, lymph node involvement, presence of distant metastasis, staging, differentiation, and risk factors, including betel quid (BQ) chewing, cigarette smoking, and alcohol consumption, was analyzed. RESULTS The majority of the patients were men (male-to-female ratio, 5.87:1) with the mean age of 57.1 +/-11.7 years. Tumors occurred mainly at the buccal mucosa (BM) (100 of 378, 26.5%), gingiva (105 of 378, 27.8%), and tongue (103 of 378, 27.2%). Neck nodal metastasis occurred frequently at the floor of the mouth (in >60% of cases), followed by the gingiva (45.7%), buccal mucosa (34%), and tongue (20.4%), whereas early distant metastasis was rare (5.3%). There were 104 (27.5%) stage 1, 96 (25.4%) stage 2, 98 (25.9%) stage 3, and 80 (21.2%) stage 4 patients. OSCC at the BM and gingiva was most (and at the tongue least) associated with risk factors of BQ use and smoking. The 5-year survival was 75%, 65.6%, 49%, and 30% for patients with stage I, II, III, and IV, respectively. The size, nodal involvement, distant metastasis, staging, differentiation, and BQ use significantly affected the survival (P <.05, Kaplan-Meier analysis). BQ use also correlated most significantly with the younger age of occurrence of OSCC patients. CONCLUSIONS Our data suggest that early treatment is the key to increasing the survival of OSCC patients. Periodic screening of high-risk populations for OSCC represents an urgent need in Taiwan.

The Impact of Falls and Fear of Falling on Health-Related Quality of Life in Taiwanese Elderly

This study aimed to investigate the relationship among falls, fear of falling (FOF), and health-related quality of life (HRQOL) in elderly people living in the community. The study was a community-based surveillance with residents aged 65 or over in Taipei, Taiwan. Data were collected in face-to-face interviews. Of the 4,056 participants, the prevalence of falls was 13.8% and the prevalence of FOF among women (62.6%) was significantly higher than that among men (46.2%). Adjusted by covariate factors, fear of falling was identified as a major factor related to HRQOL in the elderly and should be emphasized to assist the improvement of HRQOL in geriatrics.

The impact of visual impairment and use of eye services on health-related quality of life among the elderly in Taiwan: The Shihpai Eye Study

To evaluate the effect of impaired vision on health-related quality of life (HRQoL), the authors administered the Medical Outcomes Survey Short-Form 36 (SF-36) to the elderly in a metropolitan Taiwanese community and assessed their visual impairment status. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on demographics, medical history, and HRQoL. Those who were interviewed were invited to the study hospital for a detailed eye examination. An eye examination, including presenting visual acuity and best-corrected visual acuity, was conducted by ophthalmologists. Presenting visual acuity and best-corrected visual acuity were measured in the better eye. Impaired vision was defined as presenting visual acuity in the better-seeing eye worse than 6/12 (or 20/40) and was used to evaluate the correlation to HRQoL. A total of 1361 subjects at least 65 years of age participated in both the interview and eye examination. Internal-consistency and test–retest reliability of the eight scales were high. Based on the separate multiple regression model, after controlling for all other covariates, subjects in contact with vision services offered by an ophthalmologist had more positive scores on general health perceptions (β= 4.29; p < 0.001), vitality/energy (β= 2.73; p < 0.001), and mental health (β= 2.06; p= 0.01). Impaired vision was associated with significantly lower scores in physical functioning (β=−3.62; p < 0.001) and social functioning scales (β=−3.25; p= 0.015). The findings suggest that visual impairment is associated with lower quality of life and use of eye care services is associated with higher quality of life.

The Effect of Rubber Dam Usage on the Survival Rate of Teeth Receiving Initial Root Canal Treatment: A Nationwide Population-based Study

INTRODUCTION It is well-known that the usage of rubber dams during root canal treatment (RCT) improves infection control and treatment efficacy and protects patients. However, the effect of rubber dam usage on endodontic outcomes remain uncertain. The aim of the present study was to investigate whether rubber dam usage affects the survival rate of initial RCT using a nationwide population-based database. METHODS A total of 517,234 teeth that received initial RCT between 2005 and 2011 met the inclusion criteria and were followed until the end of 2011. Univariate and multivariate Cox proportional hazards models were used to estimate the effects of rubber dam usage on the risk of tooth extraction after initial RCT. RESULTS Of the 517,234 teeth, 29,219 were extracted, yielding a survival rate of 94.4%. The survival probability of initial RCT using rubber dams after 3.43 years (the mean observed time) was 90.3%, which was significantly greater than the 88.8% observed without the use of rubber dams (P < .0001). After adjusting for age, sex, tooth type, hospital level, tooth scaling frequency per year after RCT, and systemic diseases, including diabetes and hypertension, the tooth extraction hazard ratio for the RCT with rubber dams was significantly lower than that observed for RCT without rubber dams (hazard ratio = 0.81; 95% confidence interval, 0.79-0.84). CONCLUSIONS The use of a rubber dam during RCT could provide a significantly higher survival rate after initial RCT. This result supports that rubber dam usage improves the outcomes of endodontic treatments.

Factors associated with dental caries among institutionalized residents with schizophrenia in Taiwan: a cross-sectional study

BackgroundLittle research has been done on the relationship between dental caries and the personal characteristics of institutionalized residents diagnosed with schizophrenia. This study investigates the individual and treatment factors associated with the dental caries among institutionalized residents with schizophrenia in Taiwan.MethodsAn oral health survey of institutionalized residents with schizophrenia in the largest public psychiatric hospital was conducted in Taiwan in 2006. Based on this data, multiple logistic analyses were used to determine the relationship between some explanatory variables and the outcome variables of dental caries among subjects with schizophrenia.ResultsAmong the 1,108 subjects with schizophrenia, age was the only variable independently associated with DMFT > 8 (OR = 7.74, 95% CI = 3.86-15.55, p < 0.001 in comparison to residents aged 65 + years vs. 20-44 years; OR = 3.06, 95% CI = 2.03-4.61, p < 0.001 in comparison to residents aged 55-64 years vs. 20-44 years) after making adjustments for other explanatory variables. In addition, those with an education of only elementary school (OR = 1.67, 95% CI = 1.08-2.56, p = 0.021), low income (OR = 1.58, 95% CI = 1.02-2.44, p = 0.039), and length of stay (LOS) of > 10 years (OR = 2.09, 95% CI = 1.30-3.37, p = 0.002) were associated with a care index < 54.7%. Older age, lower educational level, and longer hospital stays were associated with number of remaining teeth being < 24.ConclusionsAging was the most important factor related to a high level of dental caries. Low educational level, low income, and LOS were also associated with the indicators of dental caries among institutionalized subjects with schizophrenia. It is necessary to address the treatment factors such as prolonged stay in institutions when decision-makers are planning for preventive strategies of oral health for institutionalized residents with schizophrenia.

Analysis of Facial Skeletal Characteristics in Patients With Chin Deviation

Background: This study was undertaken to investigate the facial skeletal features associated with chin deviation. Methods: Twenty‐five patients (14 males and 11 females) diagnosed with chin deviations of more than 2 mm were recruited. Fifteen skeletal landmarks, including median and lateral points, were located on posteroanterior cephalo‐grams. The CG–ANS (crista‐galli of the ethmoid–anterior nasal spine) line and the perpendicular line through the CG were used as references. The differences between the distances from paired lateral points to reference lines were examined with intraclass correlation coefficients to analyze the symmetry of facial skeletal tissue. The factors associated with the amount or direction of chin deviation were analyzed by multiple regression analysis or by logistic regression analysis. Results: Seventeen subjects (68%) showed chin deviation to the left side and 8 subjects (32%) to the right side. Sixty‐eight percent of subjects presented with Angle Class III malocclusion. Horizontal distances of all paired lateral points to the y‐axis, in mandibular body length and effective length, showed a low grade of symmetry. Only vertical distances of paired zygomaticofrontal sutures and zygonion points to the x‐axis were asymmetric. However, there were no significant asymmetries of the gonial angle, ramus height, and vertical distances from other paired lateral points to the x‐axis. The amount of chin deviation was associated with the absolute differences of the left and right antegonion to the y‐axis and zygomaticofrontal suture to the x‐axis. The direction of chin deviation was significantly associated with the difference in the effective length of bilateral mandibular halves. Conclusion: Facial skeletal asymmetry exists in patients with chin deviation. This should be considered when planning treatment for both the nonsurgical and surgico‐orthodontic cases with chin deviation.

The Relationship between Body Mass Index, the Use of Second-Generation Antipsychotics, and Dental Caries among Hospitalized Patients with Schizophrenia

Objective: Weight gain is common in schizophrenia due to use of the second-generation antipsychotic medicines (SGAs). Studies have also shown that body mass index (BMI) and the side effect of SGAs, such as anticholinergic activity, are related to the risk of dental caries. This study aims to investigate the relationship between BMI, the use of the SGAs, and the decayed, missing, and filled tooth index (DMFT) among hospitalized patients with schizophrenia. Methods: A cross-sectional survey of oral health was conducted in a psychiatric long-term care hospital in Taiwan in 2006. A total of 878 schizophrenic inpatients participated in this survey. The DMFT index was used to assess dental caries, the use of SGAs of subjects were recorded, and the BMI classification was done in accordance with Asian standard scales. Multiple regression models were used to measure the effects of SGAs or BMI on the DMFT index in each subject. Results: Among the subjects with schizophrenia, DMFT is significantly related to independent variables such as age, length of stay, BMI, education, marital status, and grade of disability. Consequent multiple linear regression showed that being underweight (β = 0.07, p = 0.041) and age were the most significant factors that influence the DMFT score. Conclusions: We found that the use of SGAs was not significantly associated with the DMFT index. After adjusting for age, being underweight is a significant factor associated with the increased risk of dental caries in hospitalized patients with schizophrenia. Psychologists and dentists should pay more attention to the relation between BMI and dental caries in this population.

Dental prosthetic treatment needs of inpatients with schizophrenia in Taiwan: a cross-sectional study

BackgroundThe need to obtain information on the dental prosthetic treatment needs (DPTNs) of inpatients with schizophrenia is unrecognized. This study aims to assess the DPTNs of this population and investigate the association between these needs and related factors.MethodsThe results of an oral health survey involving 1,103 schizophrenic adult inpatients in a long-term care institution in Taiwan were used. Chi-square tests and multiple logistic analyses were used to measure the independent effects of the characteristics of each subject on their DPTNs.ResultsOf the subjects, 805 (73.0%) were men and 298 (27.0%) were women. The mean age was 50.8 years. A total of 414 (37.5%) required fixed prosthesis, whereas 700 (63.5%) needed removable prosthesis. Multivariate analyses show that fixed prosthesis is associated with age only after adjusting for other potential independent variables. Older subjects who had a lower educational attainment or a longer length of stay required removable prosthesis.ConclusionsThe findings of this study show that the DPTNs of schizophrenic inpatients are not being met. Therefore, a special approach to the dental prosthetic treatment of these patients should be developed.

Association of Unfinished Root Canal Treatments with the Risk of Pneumonia Hospitalization

Introduction: The objective of root canal treatments (RCTs) is to control pulpal diseases and salvage infected teeth by eradicating microorganisms within the root canal system. However, an unfinished RCT can leave a space for bacterial accumulation, which can leak into the oral cavity and then aspirate into the lower respiratory tract and the lungs, causing infection. This study investigated the association of unfinished RCTs with the possible risk of pneumonia hospitalization using a nationwide population‐based database. Methods: After a matching process, we recruited 116,490 subjects who received an initiated RCT and had no history of pneumonia before 2005 and observed until the end of 2011. An unfinished RCT was operationally defined as an endodontic session that was started on a tooth but had no subsequent completion records. Cox proportional hazards models and subgroup analyses were used to estimate the association of unfinished RCTs on the risk of pneumonia hospitalization. Results: In total, 1285 subjects were hospitalized for pneumonia during 2005 to 2011 with an overall pneumonia hospitalization incidence rate of 0.22% per person year. After adjusting for confounding factors, the adjusted pneumonia hospitalization hazard ratio for subjects who had unfinished RCTs was 1.40 (95% confidence interval, 1.24–1.59) compared with subjects without unfinished RCTs (P < .0001). For middle‐aged patients, the hazard ratio was 1.81 (95% confidence interval, 1.45–2.24). Conclusions: Patients with unfinished RCTs had a higher risk of pneumonia hospitalization. Thus, dentists are advised to complete endodontic treatments once started.

Dental service use among patients with specific disabilities: A nationwide population-based study

BACKGROUND/PURPOSE The Taiwan National Health Insurance program has allocated a specific fund for dental services to patients with specific disabilities (PSDs); however, the trends and the quality are unknown. In this study, we conducted quantity analyses and quality assessments of dental service use among PSDs using a nationwide population-based database. METHODS PSDs were identified according to the codes of diagnosis fee. Quantity analyses included the number of patients receiving dental services, the number of visits, and the percentages of categories of dental service use. Quality assessments included refilling rates for operative dental treatments and unfinished rates for endodontic therapies. RESULTS For quantity analyses, dental services were accessible to 3-4% of patients with disabilities and were mostly provided to younger PSDs. The general population received more operative and endodontic therapies, and PSDs received more periodontal therapies. For quality assessments, the teeth of PSDs had a 9.74-15.07% refilling rate, which was higher than that of the general population (1.39-6.37%). Furthermore, the teeth of PSDs had a 32.03% unfinished endodontic rate, which was higher than that of the general population (21.42%). CONCLUSION During 2010-2012, only 3-4% of patients with disabilities had access to dental services, mostly provided to younger PSDs. Teeth of PSDs had higher refilling rates and unfinished endodontic sessions than the general population. We suggest that a more comprehensive dental care system is necessary to improve the quantity and quality of dental services, especially in middle-aged and older PSDs.