Michèle J. Saunders

Oral Function and Diet Quality in a Community-based Sample

Overall diet quality indices, such as the Healthy Eating Index (HEI), are preferred for epidemiological studies, yet studies in dentistry have focused on isolated dietary components. This study investigated the influence of socio-demographic and masticatory variables (masticatory performance, bite force, number of posterior functional tooth units, TMJ disorder, and dentition status) on overall diet quality in a community-based sample (n = 731). Cross-sectional data were derived from clinical examinations, bite force recordings, masticatory performance measurements, and two 24-hour dietary recalls. Females, European-Americans, and older subjects had better HEI scores than males, Mexican-Americans, and younger subjects, respectively. Income, education, and the masticatory variables were not related to diet quality. Analyses according to dentition status (good dentition, compromised dentition, partial denture, and complete dentures) showed no inter-group differences for HEI except for the age groups. The results suggest that the chewing-related factors evaluated in this sample are not predictors of overall diet quality across the socio-demographic groups.

Utilizing a 24-Hour Dietary Recall and Culturally Specific Diabetes Education in Mexican Americans With Diabetes

Two objectives were established for this study: 1) to assess the impact of a culturally specific, intensive diabetes education program on dietary patterns, and 2) to assess nutrient consumption relative to the Recommended Dietary Allowances. The study population consisted of elderly Mexican Americans with diabetes living in Harlingen and Brownsville, Texas. The experimental group (n=78) participated in an intense, 2-hour nutrition education session, while the control group (n=74) did not. The education session was conducted for groups of eight subjects via videotapes and interactive discussion. All groups experienced significant weight loss except the women in the experimental group. After the education program, however, the experimental women had increased the percentage of calories consumed daily from carbohydrate. Mean calcium consumption was substantially less than the RDA in all groups, and inadequate amounts of ascorbic acid and vitamin A often were consumed. Intensive, frequent, long-term follow-up appears essential for more sustained results.

Oral Health Issues in the Nutrition of Institutionalized Elders

Abstract Oral health is critical to systemic health and quality of life for the elderly, especially the institutionalized elderly, who are at high risk for oral and nutritional problems. Oral health is an integral component of overall nutritional health, just as nutrition plays a vital role in overall oral health. This article reviews the critical factors in the relationship among oral, nutritional, and systemic health and urges ongoing collaboration of providers of health care to reduce the rate of morbidity and mortality in institutionalized elders.

Secretion of salivary statherin is compromised in uncontrolled diabetic patients

Background Statherin is an important salivary protein for maintaining oral health. The purpose of the current study was to determine if differences in statherin levels exist between diabetic and healthy subjects. Methods A total of 48 diabetic and healthy controls were randomly selected from a community-based database. Diabetic subjects (n = 24) had fasting glucose levels > 180 mg/dL, while controls (n = 24) had levels < 110 mg/dL. Parotid saliva (PS) and sublingual/submandibular saliva (SS) were collected and salivary flow rates determined. Salivary statherin levels were determined by densitometry of Western blots. Blood hemoglobin A1c (HbA1c) and total protein in saliva were also obtained. Results SS, but not PS, salivary flow rate and total protein in diabetics were significantly less than those in healthy controls (p = 0.021 & p < 0.001 respectively). Correlation analysis revealed the existence of a negative correlation between PS statherin levels and HbA1c (p = 0.012) and fasting glucose (p = 0.021) levels, while no such correlation was found for SS statherin levels. When statherin levels were normalized to total salivary protein, the proportion of PS statherin, but not SS statherin, in diabetics was significantly less than that in controls (p = 0.032). In contrast, the amount of statherin secretion in SS, but not PS, was significantly decreased in diabetics compared to controls (p = 0.016). Conclusions and general significance The results show that synthesis and secretion of statherin is reduced in diabetics and this reduction is salivary gland specific. As compromised salivary statherin secretion leads to increased oral health risk, this study indicates that routine oral health assessment of these patients is warranted.

Intra-oral tactile sensation and aging in a community-based population

Background and aims: Intra-oral sensory function plays an important role in swallowing and food intake, yet the impact of aging on oral tactile perception is uncertain. This study examined the effects of age, ethnicity, and gender on tactile perception at specific intra-oral sites in a community-based sample of 372 Mexican-Americans (MAs) and European-Americans (EAs). Methods: Four levels of air-pressure were delivered to sites on the anterior and posterior thirds of the tongue and on the velum. Intensity judgments for suprathreshold air puffs were obtained with a direct scaling procedure. Data were analyzed by mixed model multivariate repeated measures ANOVA. Results: Mean judgments of intensity, slopes of intensity functions and intraclass correlation coefficients (ICCs) for intensity judgments, indicated that stimuli delivered to the anterior tongue elicited significantly larger and more consistent responding than at the other sites. MAs produced lower mean stimulus intensity judgments for all sites compared to EAs. No significant age-, gender- or ethnic group-related differences were found at any of the sites for the slopes of the intensity functions or for ICCs. Conclusions: Stimuli are judged more intense at the anterior tongue compared to the posterior tongue or velum and EAs gave higher estimates of intensity than did MAs. However, there are no age-, gender-, or ethnic group-related differences for the repeatability of intensity judgments or the slopes of intensity functions. Intra-oral tactile perception seems to be preserved during aging.

Geriatric Medical Education and Training in the United States

&NA; Medical education in geriatrics is an important requirement to ready the profession to provide comprehensive health care to the worlds and also Taiwans aging population. The predoctoral curricula and postdoctoral training programs in the United States were developed and supported by government agencies and professional education societies. Geriatric medical education in American medical schools has improved in the past 20 years, yet is still facing many challenges. The purposes of this paper are to review the current progress of, and propose some main principles and policies for the development of geriatric medical education and current progress in the United States. Geriatric medical education should be mandatory to adequately prepare medical students, residents, fellows, and practicing physicians to treat the elderly. The current progress and practice of geriatric medical education at the University of Texas Health Science Center at San Antonio are presented as an example.