Maria Vieira de Lima Saintrain

Impact of tooth loss on the quality of life

INTRODUCTION There is scientific evidence that shows health contributes to the quality of life. These measurements have not been well guided towards the free response of oral health in peoples lives. OBJECTIVE This study aimed to investigate the impact of tooth loss on the quality of life of elderly people. MATERIAL AND METHODS Qualitative investigation with descriptive features - which used a random sample out of the total edentulous elderly people, who lived in an institution in Fortaleza, Brazil - was carried out. From 250 residents screened, 72 completely edentulous elderly, with ages from 60 to 79 years were selected. A semi-structured questionnaire was used with closed and opened questions in which the last one was used for the free flow of the interviewees responses. The content was analysed and codified according to Bardin. RESULTS In total, 84.7% had attended the dentist to have exodontia. Of them, 81.9% reported difficulties after losing their teeth. Physical dimensions, characterised by the difficulties in eating and social dimensions, because of interference in communication with other people were obtained. CONCLUSION Tooth loss causes disorder in the individuals quality of life, mainly when it affects their well-being and appearance.

Autopercepção da condição de saúde bucal em idosos institucionalizados e não institucionalizados

This study evaluated the self-perception of oral health condition of institutionalized and non institutionalized elder population using a oral examination and a questionnaire divided in three parts: demographic data, general health and the GOHAI index. A total of 96 individuals above 60 years old living in Fortaleza, Brazil, were interviewed. They were divided in two groups, G1--institutionalized (n=48) and G2--non-institutionalized (n=48). The mean age of the study population was 69.8 years (SD 7.5) and 70.8% of the interviewed were woman. 62% had some type of medical treatment in the last year, and despite the fact that the majority (84.4%) of the elders thought that their general health was good or regular, the average number of teeth presented was 3.9 in both groups. Among them, 47.9% were using superior prosthesis and 26% inferior prosthesis. The GOHAI average was 17.53 qualifying as negative the self-perception of oral health. There was no difference between the two groups regarding physical and psychological aspects.

Saúde bucal do idoso: abordagem interdisciplinar

The aging of the Brazilian population and the resulting change in its age structure require from public policies and health professionals distinct attitudes with regard to health care delivery, focused on interdisciplinary work. This text aims at emphasizing the importance of using the problematization method in the context of an interdisciplinary approach, in which the actions shared by the different fields of knowledge converge to an interactive process towards an integrated view of the individual.

Child, neglect and oral health

BackgroundDespite advancements in oral health policies, dental caries still a problem. The lack of parents/caregiver’s care regarding child’s oral health, which characterizes neglect, may lead to a high prevalence of caries. Therefore, the objective of this study was to analyze the relation between dental caries and neglect in five year-old children.MethodsQuantitative study performed in two different moments. First, the children underwent oral examinations and physical inspection. Then, a semi-structured interview was performed with parents of children with high and low caries rate.ResultsIn all, 149 physical inspections and oral exams were performed. The number of decayed, missing and filled teeth – dmf-t was 2.75 (SD 2.83); 16 children had extremely high values (dmf-t ≥7), 85 intermediate values (1 ≤ dmf-t ≥ 6) and 48 extremely low (dmf-t = 0). Nearly all caregivers were female (96.7%; n = 29), mostly mothers (93.3%; n = 28). Associations were found between caries experience and reason of the last consultation (p = 0.011), decayed teeth and child’s oral health perception (p = 0.001). There was a trend towards a significant association between general health and decayed teeth (p = 0.079), general hygiene and caries experience (p = 0.083), and caries experience and number of times the child brushes the teeth (p = 0.086).ConclusionThere’s a relation between caries experience and children’s oral health perception by caregivers, as well as between caries experience and children’s access to dental care. There is a trend towards association between caries experience and risk factors suggestive of neglect.

Hemodialysis-Specific Factors Associated With Salivary Flow Rates

The saliva is important to maintain the integrity of tissues and teeth, besides having microbial activity. Hemodialysis (HD) patients usually have reduced salivary flow rate (SFR) and are exposed to all its associated complications. The aim of the present study was to identify HD-related factors associated with reduced SFR. A cross-sectional study was performed with maintenance HD patients. Stimulated whole saliva was collected before and after HD. Xerostomia was assessed through the validated xerostomia inventory and thirst through the dialysis thirst inventory. Parameters of dental health status were obtained by the decayed, missed, and filled teeth index and community periodontal index. One hundred twenty-eight patients (66 males) participated in this study. Stimulated SFR before HD was 0.38 ± 0.28 mL/min. In univariate analysis and after adjusting for several factors, serum urea before HD session, serum intact parathormone (iPTH), calcium-phosphorus product (Ca×Pi), serum ferritin, and number of medications were negatively correlated with SFR in univariate analysis. Moreover, patients taking sevelamer had reduced SFR in comparison with those not receiving it (SFR 0.32 ± 0.19 vs. 0.44 ± 0.23 mL/min, P = 0.003). At multivariate analysis, including dialysis and nondialysis-related factors, age, elevated pre-HD serum urea, higher Ca×Pi product, higher iPTH, and sevelamer use remained as factors that were independently associated with a reduced SFR. After dialysis, there was a significant increment in SFR (0.39 ± 0.28 vs. 0.60 ± 0.34 mL/min, P < 0.001). Several HD-related features were associated with reduced SFR, including serum urea, sevelamer use, and bone and mineral disorders markers.

Depression Symptoms and Oral Discomfort in Elderly Adults

VITA: Study design, recruitment strategies and level of participation. J Neural Transm 2002;62(Suppl):103–116. 4. Fischer P, Jungwirth S, Hinterberger M et al. Reversible Alzheimer’s disease. J Am Geriatr Soc 2011;59:1137–1138. 5. Stetler C, Miller GE. Depression and hypothalamic-pituitary-adrenal activation: A quantitative summary of four decades of research. Psychosom Med 2011;73:114–126. 6. Dotson VM, Beydoun MA, Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 2010;75:27–34. 7. Lee BK, Glass TA, Wand GS et al. Apolipoprotein E genotype, cortisol and cognitive function in community dwelling older adults. Am J Psychiatry 2008;165:1456–1464. 8. Karlamangla AS, Singer BH, Chodosh J et al. Urinary cortisol excretion as a predictor of incident cognitive impairment. Neurobiol Aging 2005;26 (Suppl 1):80–84. 9. Rothman SM, Mattson MP. Adverse stress, hippocampal networks and Alzheimer’ disease. NeuroMol Med 2010;12:56–70. 10. Hinterberger M, Fischer P. Folate and Alzheimer: When time matters. J Neural Transm 2013;120:211–224.

Salivary tests associated with elderly people’s oral health

INTRODUCTION The saliva constitutes essential condition for the individuals health. AIM Identify the relation of the salivary flow and saliva pH with medicine use and oral discomfort in elderly. METHODS AND MATERIALS Cross-sectional study with 68 elderly living in a long staying institution. Salivary tests were performed based on Bo Krasses methodology. For pH, the Universalindikator - Merck tape was used. A questionnaire was applied, organising data through Software SPSS version 17. Pearsons qui-square distribution, Fishers exact test and t-test for paired data were used, with significance level of 5% and confidence interval of 95%. RESULTS Among the 68 elderly (average of 70.4 years, SD ± 7.27), 80% showed normal pH. The rate of salivary flow was as follows: very low, 32.3%; lowered, 41.2%; and normal, 25.5%; 30.9% reported dry mouth; 22.1% problems with taste; 17.6%, dysphagia; and 14.7%, burning mouth. 76.5% used medicines. There was statistical significance between medicine use and dry mouth (p = 0.015). They showed an association between salivary flow and medicine use (p = 0.048), feels dry mouth (0.018) and difficulty to swallow (p = 0.046), and saliva pH without stimulation and feels dry mouth (p = 0.003), difficulty to swallow (p=0.006) and burning mouth sensation (p = 0.014). CONCLUSION Low salivary flow and saliva pH interfere on elderly peoples health and medicine use influences on results.

Application of the community oral health indicator by non-dental personnel and its contribution to oral healthcare.

Objective To validate the Community Oral Health Indicator-COHI by non-dental personnel. Methods Risk assessment is an essential component in the decision-making process. Therefore, the COHI, an instrument to evaluate population oral health situation in a simple manner, was created. Community Health Agents (CHA) were trained to use the COHI (variables as number of teeth, presence of cavities, residual dental roots, oral lesions, etc.), while dentists for the COHI and DMFT. 60 individuals were examined, by CHA and DS, with these indicators in order to validate the use of COHI by non-dental personnel. Results Dental and soft tissues problems were well spread among those individuals. People with and without soft tissue damage, as well as with and without use and/or need for prostheses were found in the sample, proving it to be a heterogeneous population for the evaluated factors and representing the real population. The results of examinations performed by dentists using the COHI and DMF-T/dmf-t presented strong agreement when comparing the two instruments. When COHI and DMFT were compared, the results showed a concordance of 0.86 for the number of present teeth, and 0.85 for the number of residual roots. Likewise, when analyzing the data comparing the use of the COHI by DS and CHA a high agreement level, specificity and sensitivity was found. Conclusion The COHI has shown to be useful for detecting problems in oral health. Therefore, COHI may be used, after training, by non-dental personnel, contributing to the planning and organization of the community dental assistance.

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. Conclusions: No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

Prevalence of oral and maxillofacial trauma in elders admitted to a reference hospital in northeastern Brazil

Objective To know the prevalence and etiology of oral and maxillofacial trauma in elders. Methods Analytical quantitative cross-sectional study conducted at a public trauma hospital located in Fortaleza-Ceará, Brazil. The study population comprised patients with trauma who were hospitalized from April to August 2014. Of these patients, patients with oral and maxillofacial trauma were chosen to be included in the research. A questionnaire was administered in order to obtain information on socio-demographics, systemic comorbidities, use of medication, deleterious habits (smoking and alcohol consumption), etiology of oral and maxillofacial trauma and type of pre-hospital care. Results Of the 280 elderly hospitalized with trauma, 47 had oral and maxillofacial trauma, with a prevalence of 16.8%. In this group, the age ranged from 60 to 88 years, with a mean age of 72.4 years (SD± 8.38). The elderly were mostly women (55.3%), self-declared pardos (53.2%), who presented with cardiovascular disorders (48.9%), and who received formal pre-hospital care (70.2%). Elderly who were in the 60–69 years age group, spent 6–9 years at school and drank alcohol were 2.64, 3.75, and 1.97, respectively, more likely to suffer oral and maxillofacial trauma. The main causes of trauma were physical aggression, traffic accidents, falls and domestic accidents. All of the physical aggressions resulted in oral and maxillofacial traumas, and the elderly who suffered traffic accidents were four times more likely to have oral and maxillofacial trauma. Conclusion The prevalence of 16.8% and the lack of research on oral and maxillofacial traumas in the elderly is worrisome and should be included in the oral health indicators for the elderly population to support the importance of oral health.