Oral health and oral implant status in edentulous patients with implant-supported dental prostheses who are receiving long-term nursing care.

Maxillofacial Unit, Division of Hospital Dentistry, Specialisttandvården, Länssjukhuset, Halmstad, Sweden.
Gerodontology (Impact Factor: 0.81). 07/2009; 26(4):245-9. DOI: 10.1111/j.1741-2358.2009.00275.x
Source: PubMed

ABSTRACT The aim of this study was to investigate oral health and oral implant status in a group of edentulous patients receiving long-term residential or nursing care (LTC), all of whom had implant-supported fixed or removable dental prostheses.
A dental examination was performed on a total of 3310 patients receiving LTC and from this population 35 edentulous patients in whom dental implants had been placed formed the cohort for this study. All examinations were performed by a specialist in hospital dentistry and took place in the patients' own home environment. Oral health was assessed by means of a protocol which evaluated oral hygiene status, possible oral mucosal inflammation and oral mucosal friction levels. Any problems with the implant-supported prosthesis, implant mobility or other complications were also assessed. In addition, patients were asked about any oral symptoms and their usual oral hygiene procedures.
About half of the subjects (17/35) were registered as having no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral hygiene. Twenty-one of the 35 patients depended on help from the nursing personnel for their daily oral hygiene procedures. Obvious problems with food impaction were noted in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full arch-fixed prostheses and three implant-borne overdentures. There was no evidence of mobility or fractures of either the implants or the prostheses. Fifteen implants showed some exposed screw threads. Pus was exuding from one implant site and general peri-implant gingival hyperplasia was noted in two patients. Twenty-four patients were completely satisfied with the function and appearance of their implant-supported prostheses. Two patients were totally dissatisfied.
This study indicates that oral implant therapy can be considered as a treatment of choice in elderly patients, even if oral hygiene is sub-optimal.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Two important factors contribute to a higher chance of a deterioration of oral health status in frail and disabled elderly people. First, advances in oral health care and treatment have resulted in a reduced number of edentulous individuals and the proportion of adults who retain their teeth until late in life has increased substantially. Second, neglected self-care and/or professional care have led to reduced oral health care utilization. This review reports the consequences of having a poor oral health status and its impact on general health of frail elderly people and gives an overview of the important enabling and disabling factors regarding the provision of oral health care to frail older persons. Impaired cognitive and functional ability, medication-induced hyposalivation, reduced saliva buffer capacity and high saliva acidity, diabetes mellitus, the number of exposed root surfaces due to gingival recession, poor oral hygiene, high frequency of sugar consumption, and poor socio-economic conditions are the major predisposing conditions for the upsurge of caries in older population groups. Poor oral hygiene, tobacco smoking, and excessive alcohol consumption together with some systemic diseases, such as metabolic syndrome, rheumatoid arthritis, diabetes mellitus and post-menopausal osteoporosis are reported to be important risk factors for periodontal disease and later on peri-implantitis. Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor. The introduction of innovative care pathways to improve oral health care of elderly people by implementing new guidelines or health care models appears to be a complex process. Therefore, a poor oral health status might be regarded as a new geriatric giant in frail elderly people, which deserves urgent attention of scientists, health care providers and policymakers.
    European geriatric medicine 11/2013; 4(5):339–344. · 0.55 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the influence of bone tissue type on stress distribution in full-arch implant-supported fixed prostheses using a three-dimensional finite element analysis. Stresses in cortical and trabecular bones were also investigated. Edentulous mandible models with four implants inserted into the interforaminal region were constructed from different bone types: type 1 — compact bone; type 2 — compact bone surrounding dense trabecular bone; type 3 — a thin layer of compact bone surrounding trabecular bone; and type 4 — low-quality trabecular bone. The mandible was restored with a full-arch implant-supported fixed prosthesis. A 100-N oblique load was applied to the left lower first molar of the prosthesis. The maximum (σmax) and minimum (σmin) principal stress values were determined. The σmax in the type 4 cortical bone was 22.56% higher than that in the type 1 bone. The σmin values in the cortical bone were similar among all the bone types. For the superstructure, increases of 9.04% in the σmax and 11.74% in the σmin in G4 (type 4 bone) compared with G1 (type 1 bone) were observed. For the implants, the highest stress values were located in G4, and the lowest values were observed in G1. In the trabecular bone, the highest stress was generated in G1 and G2. In conclusion, the more compact bones (types 1 and 2) are the most suitable for supporting full-arch implant-supported fixed prostheses, and poor bone quality may increase the risk of biological and mechanical failure.
    Materials Science and Engineering: C. 04/2014; 37:164–170.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Oral function with removable dentures is improved when dental implants are used for support. A variety of methods is used to measure change in masticatory performance, bite force, patient's satisfaction and nutritional state. A systematic review describing the outcome of the various methods to assess patients' appreciation has not been reported. The objective is to systematically review the literature on the possible methods to measure change in masticatory performance, bite force, patient's satisfaction and nutritional state of patients with removable dentures and to describe the outcome of these. Medline, Embase and The Cochrane Central Register of Controlled Trials were searched (last search July 1, 2014). The search was completed by hand to identify eligible studies. Two reviewers independently assessed the articles. Articles should be written in English. Study design should be prospective. The outcome should be any assessment of function/satisfaction before and at least 1 year after treatment. Study population should consist of fully edentulous subjects. Treatment should be placement of any kind of root-form implant(s) to support a mandibular and/or maxillary overdenture. Fifty-three of 920 found articles fulfilled the inclusion criteria. A variety of methods was used to measure oral function; mostly follow-up was 1 year. Most studies included mandibular overdentures, three studies included maxillary overdentures. Implant-supported dentures were accompanied by high patient's satisfaction with regard to denture comfort, but this high satisfaction was not always accompanied by improvement in general quality of life (QoL) and/or health-related QoL. Bite force improved, masseter thickness increased and muscle activity in rest decreased. Patients could chew better and eat more tough foods. No changes were seen in dietary intake, BMI and blood markers. Improvements reported after 1 year apparently decreased slightly with time, at least on the long run. Treating complete denture wearers with implants to support their denture improves their chewing efficiency, increases maximum bite force and clearly improves satisfaction. The effect on QoL is uncertain, and there is no effect on nutritional state.
    Journal of Oral Rehabilitation 10/2014; 42(3). · 1.93 Impact Factor

Full-text (2 Sources)

Available from
May 26, 2014