Ralph H. Saunders

Parotid and whole saliva in the prediction of serum total and free phenytoin concentrations

Epileptic outpatients (22 male and 12 female) participated in this study. All were taking phenytoin and 20 were taking one or more additional antiepileptic drugs. The mean percent free phenytoin in serum was 11.0% whether the patient was taking phenytoin alone or in combination with other antiepileptic drugs. There was a strong linear relationship between the serum total and ultrafiltrate phenytoin concentrations, the slope of the regression line being 0.109. There was also a strong relationship between the phenytoin concentrations in serum ultra filtrate and each of four salivary fractions, but each salivary fraction significantly underestimated the mean serum ultrafiltrate phenytoin concentration. It should be noted, however, that in this study the saliva fractions collected were relatively large (7 ml), and it is possible that collection conditions such as these may influence the salivary phenytoin concentration. The supernatant of whole saliva had a significantly lower concentration of phenytoin than whole saliva itself (due to binding of the drug to the mucoid sediment). Parotid saliva appears to be the best predictor of serum ultrafiltrate phenytoin concentrations. Contrary to expectation, gingivitis, at least as defined here, appeared to have no effect on the predictability of serum ultrafiltrate phenytoin concentrations by the salivary fractions, but this conclusion is a qualified one.

Anterior tooth wear and quality of life in a nursing home population

AIMS The aim of the study was to assess the extent to which a relationship may exist between the wear of the anterior teeth and quality of life in a population of nursing home residents. METHODS AND RESULTS A population (n = 100) of nursing home residents (mean age 75.7 years) was recruited all members of which had at least 4 upper and 4 lower anterior teeth and were assessed as cognitively intact by nursing personnel who were familiar with their behavior. The investigator evaluated the level of tooth wear of each subject according to the Tooth Wear Index of Donachie and Walls (Adapted) and then verbally administered the Geriatric Oral Health Assessment Index (GOHAI) of Atchison and Dolan. Analyses did not reveal significant differences in tooth wear between males and females nor between age and GOHAI score; however, tooth wear was positively related to age and inversely related to quality of life. CONCLUSIONS Results suggest that tooth wear is negatively related to quality of life.

Partial denture swallowed by patient with dementia.

PURPOSE To present a rare case of a male dementia patient in a nursing home who swallowed a partial denture which lodged in the airway. METHODS During breakfast, a patient with moderate dementia experienced a sore throat, labored breathing, and difficulty swallowing. Uncertainty about the cause of these problems was exacerbated by the patients cognitive losses, his reduced oro-motor function, and awareness of caregivers that the possible involvement of a denture of this size was unlikely. At the beginning of the third day, he developed a low-grade fever and was placed on antibiotics. A chest x-ray was negative. RESULTS On the fourth day, a flexible endoscopic evaluation of swallowing was performed, which revealed the partial denture resting in the hypopharynx on the patients vocal cords. DISCUSSION Along with pneumonia and viral bronchitis, a swallowed denture needs to be in the differential diagnosis of a dementia patient experiencing difficulty swallowing. CONCLUSIONS Nursing home caregivers be aware that even a sizable partial denture can be swallowed and extra vigilance is essential in caring for dementia patients.

Special care dentistry.

The mission of Special Care in Dentistry is to provide a forum for research findings, case reports, clinical techniques and scholarly discussion relevant to the oral health and oral health care of “special care patients.” The designation of the special care patient is not limited to hospitalized, disabled or older individuals, but includes all patients for whom oral health and oral health care are complicated by physical, emotional, financial and/or access factors.