No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Effects of an oral health program on the occurrence of oral candidosis in a long-term facility
Abstract
The aim was to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. Half of the residents were included in an experimental group which benefited from a preventive oral hygiene program including instruction of the carers and implementation of a recall program for professional oral hygiene care.
Intraoral examinations and yeast cultures from the oral mucosa and the fitting denture surface were carried out at baseline and 18 months later. The outgrowth of yeast was estimated on Oricult-N dip slides using the scale: no growth; 1-20 colonies; 21-100 colonies; >100 colonies.
At baseline (n = 237) and at 18 months (n = 159) the experimental and the control groups were similar with regard to the residents' distribution by age, sex, dental and prosthetic status and prevalence of denture stomatitis. The 78 residents lost had the same baseline characteristics as the survivors, except for being older. In the experimental group the severity of the inflammation of the palate decreased (P = 0.005) as well as the prevalence of glossitis (P = 0.005). At baseline high yeast scores from the mucosa (>20) were observed in about 50% of the residents in the experimental as well as the control group. At 18 months this figure was 23.4% for the experimental and 48.7% for the control group (P = 0.001). There was also a reduction of the number of residents with positive cultures and the denture yeast scores at 18 months in the experimental group (P = 0.05).
This study has shown that the preventive program was effective in reducing the colonization of the oral mucosa and dentures by Candida and thereby improving the health of the oral mucosa.
... Four studies were conducted in Australia [30][31][32][33] ; one in the United States 34 ; three in Canada [35][36][37] ; three in the UK [38][39][40] ; thirteen in Europe including two in Germany, 41,42 three in the Netherlands, [43][44][45] one in Belgium, 46 two in Switzerland, 47,48 and-from the Scandinavian countries-three in Sweden, 49-51 one in Norway 52 and one in Denmark 53 ; ...
... Four distinct oral health workforce models were iteratively identified from the studies: nurse-led training of aged care nurses, 30,34,38,46 oral health professional-led training of aged care nurses, 35,36,[39][40][41]43,44,50,51 oral health professional-led training of nurses with ongoing clinical support [31][32][33]37,42,[47][48][49]52,53,58 and oral health professional support only. [54][55][56][57] Study results including the demographics and the quality appraisal are reported within these models (Tables 1 and 2). ...
... Medium-term outcomes included gingival bleeding (n = 7), where four37,38,41,50 studies showed positive outcomes that were statistically significant. Soft tissues outcomes were reported in eight studies across three models of care, where five30,38,39,47,49 of these studies showed positive outcomes that were statistically significant. ...
Background
In Australia and globally, there is an increasing problem of unmet oral health needs of older people above 65 residing in aged care facilities. Various workforce models have been trialled to implement oral health care programmes in aged care facilities, but the evidence behind these programmes and their underlying workforce models is not known.
Objective
To systematically review the literature on the effectiveness, and economic feasibility of the current workforce models addressing oral care in aged care facilities.
Methods
CINAHL, Cochrane CENTRAL, MEDLINE, EMBASE, EMB Reviews, NHS Economic Evaluation Database and grey literature were searched. Studies were included if they described an oral health workforce model with a clinical intervention and defined oral health outcome measures. Analysis was conducted using the NHMRC guidelines for scientific and economic evaluations.
Results
Twenty‐eight studies were included. Four distinct workforce models of care were identified. 60% of the studies demonstrated short‐term effectiveness in clinical measures. Workforce models were similar in their effectiveness, with varying levels of quality within each model. Although three studies considered individual components of economic feasibility, only one provided a comprehensive economic analysis of both the costs and health outcomes.
Conclusions Implications of findings
All workforce models of care had some positive impact on oral health for residents of aged care. Oral health should be included as a health focus in age care facilities. Future studies should include longer‐term health outcomes with rigorous economic analysis to ensure sustainably delivered workforce models of care for oral health management within aged care.
... Barthel Index was used for assessing the level of dependency. (11) A pre-tested proforma was used to record, which included recording of dental plaque, debris, denture plaque, and denture stomatitis. ...
... The palatal area was examined and denture stomatitis classified according to the method described by Schou et al. (15) The denture bearing mucosa of maxillary jaw was scored on a 0-3 scale according to the classification of Budtz-Jørgensen et al.: (11) 0. Stomatitis not present. 1. Pin-point erythema. ...
... The relationship between high denture plaque levels and diffuse erythema/papillary hyperplasia (i.e., Grade 2 and 3 denture induced stomatitis) is well documented. These findings were similar to the results from the study Budtz-Jorgensen et al., (11) Frenkel et al., (10) and Nicol et al. (21) General preventive measures are essential to promoting good oral and general health in the elderly, including daily oral hygiene practices, with specific attention to control of dental plaque and xerostomia, regular oral health assessment, and dietary awareness. ...
ABSTRACT Background/Introduction For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral hygiene status would need urgent care. Objective To assess the oral hygiene status of institutionalized dependent elderly in Bangalore City, India. Methods A cross-sectional study of 322 dependent elderly patients was conducted at seven elderly homes of Bangalore City, India. The oral hygiene status recorded includes dental and prosthetic hygiene. Results The mean Debris Index and Plaque Index scores of dentate elderly were 2.87±0.22 and 3.17±0.40, respectively, the mean Denture Plaque and Denture Stomatitis scores were 3.15±0.47 and 1.43±0.68, respectively. Conclusion The dental hygiene was inadequate. This study emphasizes the care demand and the need for help in oral hygiene procedures for the dependent institutionalized elderly.Key words: dependent elderly, institutionalized elderly oral health, elderly oral hygiene status
... At baseline, a pro forma with details of every resident of the random sample was completed. The pre-tested pro forma was used to record, dental plaque, debris, denture plaque and denture stomatitis using the debris component of the Simplified Oral Hygiene Index (OHI-S), (7) the Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index, (8) a denture plaque index (Addictive Index for Plaque Accumulation by Armbjornsen (as noted in the article by Augsburger et al. (9) ), and a denture stomatitis /denture-induced stomatitis test (i.e., the palatal area was examined and denture stomatitis classified according to the method described by Budtz-Jorgensen et al. (6) In addition, oral-hygiene knowledge and practices among the elderly were collected using a questionnaire. The Barthel Index was used for assessing the level of dependency. ...
... The Barthel Index was used for assessing the level of dependency. (6) Furthermore, at baseline and at six months, a questionnaire addressing the caretakers was completed, which included the knowledge of oral health among the caretakers. At baseline, oral-health education for the caretakers was provided using a PowerPoint presentation to the study group. ...
... There was significant reduction of the denture stomatitis score from baseline to post-intervention (p < .001). These results were similar to the results from the studied by Budtz Jorgensen et al. (6) Frenkel et al. (2) and Nicol et al. (13) and in contrast with the results from the study conducted by Schou et al. (3) There was also a significant improvement in the frequency of cleaning and the usage of materials for cleaning which was reflected in the reductions in the denture plaque and denture stomatitis scores at post-intervention. ...
Background
The population of older people, as well as the number of dependent
older people, is steadily increasing; those unable to
live independently at home are being cared for in a range of
settings. Practical training for nurses and auxiliary care staff
has frequently been recommended as a way of improving oral
health care for functionally dependent elderly. The aim was
improve oral hygiene in institutionalized elderly in Bangalore
city by educating their caregivers.
Methods
The study is a cluster randomized intervention trial with
an elderly home as unit of randomization in which 7 out of
65 elderly homes were selected. Oral health knowledge of
caregivers was assessed using a pre-tested pro forma and
later oral-health education was provided to the caregivers of
the study group. Oral hygiene status of elderly residents was
assessed by levels of debris, plaque of dentate and denture
plaque, and denture stomatitis of denture wearing residents,
respectively. Oral-health education to the caregivers of control
group was given at the end of six months
Results
There was significant improvement in oral-health knowledge
of caregivers from the baseline and also a significant
reduction of plaque score from baseline score of 3.17 ± 0.40
to 1.57 ± 0.35 post-intervention (p < .001), debris score
2.87 ± 0.22 to 1.49 ± 0.34 (p < .001), denture plaque score
3.15 ± 0.47 to 1.21 ± 0.27 (p < .001), and denture stomatitis
score 1.43 ± 0.68 to 0.29 ± 0.53 (p < .001).
Conclusions
The result of the present study showed that there was a significant
improvement in the oral-health knowledge among
the caregivers and oral-hygiene status of the elderly residents.
Key words: oral-health promotion, oral-health education, oral
disease prevention, elderly people, caregivers
... Numerous authors have conducted randomized controlled trials testing the extent that various interventions improve the oral health of NH residents. These interventions include daily regular tooth brushing by NH caregivers, 26,27 daily power tooth brushing provided by either caregivers 28,29 or oral care professionals, 30 daily tooth brushing in combination with scaling and root planing, 26,27,30,31 other forms of care such as tongue brushing, use of oral rinses, application of chlorhexidine varnish, medicated chewing gum [32][33][34][35] and educational sessions provided by oral care professionals to NH caregivers. [36][37][38] As a general rule, the most effective of these oral health intervention studies involve scaling and root planing, however only when accompanied by daily brushing. ...
... Numerous authors have conducted randomized controlled trials testing the extent that various interventions improve the oral health of NH residents. These interventions include daily regular tooth brushing by NH caregivers, 26,27 daily power tooth brushing provided by either caregivers 28,29 or oral care professionals, 30 daily tooth brushing in combination with scaling and root planing, 26,27,30,31 other forms of care such as tongue brushing, use of oral rinses, application of chlorhexidine varnish, medicated chewing gum [32][33][34][35] and educational sessions provided by oral care professionals to NH caregivers. [36][37][38] As a general rule, the most effective of these oral health intervention studies involve scaling and root planing, however only when accompanied by daily brushing. ...
... [36][37][38] As a general rule, the most effective of these oral health intervention studies involve scaling and root planing, however only when accompanied by daily brushing. 26,27,30,39 Unfortunately, these types of interventions require the ongoing services of oral health professionals, which is not likely feasible or sustainable given the cost implications. ...
Objectives:
The aim of this study was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (Oral-B Professional Care 1000(™) ) in nursing home (NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation.
Methods:
In this repeated measures single-blinded randomized controlled trial, 59 residents of one NH in Winnipeg, Canada, were randomized to receive either twice-daily tooth brushing with a rotating-oscillating power toothbrush (PB) or UC by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6 weeks, which included: inflammation (MGI, Lobene), bleeding (PBI, Loesche) and Plaque (Turesky). Comparisons of group changes in outcomes were analysed using an ANOVA with a repeated measure.
Results:
Of 59 original study participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time (P<.0001), with no differences between groups.
Conclusions:
These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding, a direct measure of periodontal inflammation, which is a unique finding.
... Barthel Index was used for assessing the level of dependency. (11) A pre-tested proforma was used to record, which included recording of dental plaque, debris, denture plaque, and denture stomatitis. ...
... The palatal area was examined and denture stomatitis classified according to the method described by Schou et al. (15) The denture bearing mucosa of maxillary jaw was scored on a 0-3 scale according to the classification of Budtz-Jørgensen et al.: (11) 0. Stomatitis not present. 1. Pin-point erythema. ...
... The relationship between high denture plaque levels and diffuse erythema/papillary hyperplasia (i.e., Grade 2 and 3 denture induced stomatitis) is well documented. These findings were similar to the results from the study Budtz-Jorgensen et al., (11) Frenkel et al., (10) and Nicol et al. (21) General preventive measures are essential to promoting good oral and general health in the elderly, including daily oral hygiene practices, with specific attention to control of dental plaque and xerostomia, regular oral health assessment, and dietary awareness. ...
Background
The population of older people, as well as the number of dependent older people, is steadily increasing; those unable to live independently at home are being cared for in a range of settings. Practical training for nurses and auxiliary care staff has frequently been recommended as a way of improving oral health care for functionally dependent elderly. The aim was improve oral hygiene in institutionalized elderly in Bangalore city by educating their caregivers. Methods
The study is a cluster randomized intervention trial with an elderly home as unit of randomization in which 7 out of 65 elderly homes were selected. Oral health knowledge of caregivers was assessed using a pre-tested pro forma and later oral-health education was provided to the caregivers of the study group. Oral hygiene status of elderly residents was assessed by levels of debris, plaque of dentate and denture plaque, and denture stomatitis of denture wearing residents, respectively. Oral-health education to the caregivers of control group was given at the end of six months Results
There was significant improvement in oral-health knowledge of caregivers from the baseline and also a significant reduction of plaque score from baseline score of 3.17 ± 0.40 to 1.57 ± 0.35 post-intervention (p < .001), debris score 2.87 ± 0.22 to 1.49 ± 0.34 (p < .001), denture plaque score 3.15 ± 0.47 to 1.21 ± 0.27 (p < .001), and denture stomatitis score 1.43 ± 0.68 to 0.29 ± 0.53 (p < .001). Conclusions
The result of the present study showed that there was a significant improvement in the oral-health knowledge among the caregivers and oral-hygiene status of the elderly residents.
Key words: oral-health promotion, oral-health education, oral disease prevention, elderly people, caregivers
... The purpose of such intervention is, usually, education of nursing home staff in oral health and implementation of recall programmes for the residents. 10,11 In this way, the oral status of nursing home populations can be successfully improved. 11 There is, however, evidence that these effects decrease after longer periods of observation and that renewal is necessary, 12,13 and a recent meta-analysis was unable to draw robust conclusions about the effect of educational intervention on nursing home staff and residents. ...
... 10,11 In this way, the oral status of nursing home populations can be successfully improved. 11 There is, however, evidence that these effects decrease after longer periods of observation and that renewal is necessary, 12,13 and a recent meta-analysis was unable to draw robust conclusions about the effect of educational intervention on nursing home staff and residents. 14 Available data on interventional studies of the oral health of older people with severe care-dependence or cognitive impairment are especially limited, because these characteristics have been defined as exclusion criteria in many previous studies on oral care in nursing homes. ...
Objectives
The purpose of this work was to investigate the long‐term effectiveness of oral health education of caregivers in nursing homes with care‐dependent and cognitively impaired residents.
Methods
Fourteen nursing homes with a total of 269 residents were allocated to a control group, with continued normal care, or to an intervention group. Allocation was performed at nursing home level. In the intervention group, caregivers were given oral health education, and ultrasonic cleaning devices were provided to clean removable prostheses. Oral health was assessed at baseline and after 6 and 12 months by use of the Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Community Periodontal Index of Treatment Needs (CPITN) and Denture Hygiene Index (DHI). Mixed models for repeated measures were performed for each target variable, with possible confounding factors (intervention/control group, age, sex, residence location and care‐dependence).
Results
In the control group, no changes of target variables were observed between baseline and the 6‐ and 12‐month follow‐ups. After 6 and 12 months, PCR and DHI were significantly improved in the intervention group. For PCR, the intergroup difference of improvements was −14.4 (95% CI: −21.8; −6.9) after 6 months. After 12 months, the difference was −16.2 (95% CI: −27.7; −4.7). For DHI, the intergroup difference compared to baseline was −15 (95% CI: −23.6; −6.5) after 6 months and −13.3 (95% CI: −24.9; −1.8) after 12 months. There was neither a statistically significant effect on GBI nor on CPITN. Care‐dependency showed a substantial trend to smaller improvements in PCR (P = .074), while an inverse effect was apparent for DHI (P < .001).
Conclusions
Education of caregivers improves and maintains the oral health of care‐dependent nursing home residents over longer periods. Use of ultrasonic devices is a promising means of improving denture hygiene among the severely care‐dependent. Such interventions can be easily and cheaply implemented in routine daily care.
... In LTC facilities high yeast scores indicating oral candidiasis have been reported in 9% to 65% of the residents. 27 The therapeutic effect of improved oral hygiene measures has been demonstrated on oral candidiasis associated with denture wearing in community-dwelling older adults. Budtz-Jørgensenet al 27 conducted a study to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. ...
... 27 The therapeutic effect of improved oral hygiene measures has been demonstrated on oral candidiasis associated with denture wearing in community-dwelling older adults. Budtz-Jørgensenet al 27 conducted a study to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. The study concluded that the preventive program was effective in reducing the colonization of the oral mucosa and dentures by Candida and thereby improving the health of the oral mucosa. ...
... In healthy edentulous populations, Candida species found in oral cavity range from 20% to 50%, whereas denture users have as many as 75% (Radford et al, 1998). Oral candidiasis manifests itself in various forms, such as atrophic glossitis, median rhomboid glossitis, denture stomatitis, and angular cheilitis (Budtz-Jorgensen et al, 2000). ...
Diabetics are more likely to develop oral disease, such as candidiasis. One of the most prevalent oral manifestation in most denture wearers is Candida-associated denture stomatitis. The purpose of this study to explain the pathophysiology and management of denture stomatitis in the diabetic senile patient. Oral candidiasis is the highest prevalence of oral mucosal opportunistic infections. One of the things that can induce oral candidiasis is diabetes mellitus, which is associated with poorly controlled or neglected glycaemic control. Several studies have revealed that Candida species biofilms can be found on abiotic surfaces of dentures. The ability of Candida Species to infect niche hosts is very diverse, supported by various virulence factors and the internal ability of Candida species, the most common species were C. albicans. Denture stomatitis in the diabetic senile patient requires proper management to achieve the successful treatment. In conclusion, diabetic senile patients with dentures can increase the risk of denture stomatitis. Good glycaemic control and periodic denture control are needed to minimize the occurrence of denture stomatitis. Proper management of cases of denture stomatitis can reduce the risk of further spreading the infection and morbidity.
... Oral candidiasis is one of the most common oral infections in patients receiving immunotherapy and in older individuals with weak immunity [1]. Oral candidiasis related to wearing dentures is called denture stomatitis (DS) [2,3]. Candida albicans (C. ...
This study aimed to investigate the effect of ozone ultrafine bubble water (OUFBW) on the formation and growth of Candida albicans ( C . albicans ) biofilms and surface properties of denture base resins. OUFBWs were prepared under concentrations of 6 (OUFBW6), 9 (OUFBW9), and 11 ppm (OUFBW11). Phosphate buffered saline and ozone-free electrolyte aqueous solutions (OFEAS) were used as controls. Acrylic resin discs were made according to manufacturer instructions, and C . albicans was initially cultured on the discs for 1.5 h. A colony forming unit (CFU) assay was performed by soaking the discs in OUFBW for 5 min after forming a 24-h C . albicans biofilm. The discs after initial attachment for 1.5 h were immersed in OUFBW and then cultured for 0, 3, and 5 h. CFUs were subsequently evaluated at each time point. Moreover, a viability assay, scanning electron microscopy (SEM), Alamar Blue assay, and quantitative real-time polymerase chain reaction (qRT-PCR) test were performed. To investigate the long-term effects of OUFBW on acrylic resin surface properties, Vickers hardness (VH) and surface roughness (Ra) were measured. We found that OUFBW9 and OUFBW11 significantly degraded the formed 24-h biofilm. The time point CFU assay showed that C . albicans biofilm formation was significantly inhibited due to OUFBW11 exposure. Interestingly, fluorescence microscopy revealed that almost living cells were observed in all groups. In SEM images, the OUFBW group had lesser number of fungi and the amount of non-three-dimensional biofilm than the control group. In the Alamar Blue assay, OUFBW11 was found to suppress Candida metabolic function. The qRT-PCR test showed that OUFBW down-regulated ALS1 and ALS3 expression regarding cell-cell, cell-material adhesion, and biofilm formation. Additionally, VH and Ra were not significantly different between the two groups. Overall, our data suggest that OUFBW suppressed C . albicans growth and biofilm formation on polymethyl methacrylate without impairing surface properties.
... Current treatments for CADS include the use of topical antifungal agents repeatedly applied to both the mucosa and the denture surface, but the re-infection rate is extremely high. Regular professional oral care, including simply removing dentures at night and leaving them to dry in the air, results in a decrease in the number of positive Candida cultures as well as a decrease in oral mucosal inflammation [14]. Moreover, incorporating professional oral care, including denture hygiene, resulted in a lower incidence of pneumonia, and a decrease in the number of febrile days in this frail population [15]. ...
Biofilms play a crucial role in the development of Candida-associated denture stomatitis. Inhibition of microbial adhesion to poly(methyl methacrylate) (PMMA) and phosphate containing PMMA has been examined in this work. C. albicans and mixed salivary microbial biofilms were compared on naked and salivary pre-conditioned PMMA surfaces in the presence or absence of antimicrobials (Cetylpyridinium chloride [CPC], KSL-W, Histatin 5 [His 5]). Polymers with varying amounts of phosphate (0–25%) were tested using four C. albicans oral isolates as well as mixed salivary bacteria and 24 h biofilms were assessed for metabolic activity and confirmed using Live/Dead staining and confocal microscopy. Biofilm metabolism was reduced as phosphate density increased (15%: p = 0.004; 25%: p = 0.001). Loading of CPC on 15% phosphated disks showed a substantial decrease (p = 0.001) in biofilm metabolism in the presence or absence of a salivary pellicle. Salivary pellicle on uncharged PMMA enhanced the antimicrobial activity of CPC only. CPC also demonstrated remarkable antimicrobial activity on mixed salivary bacterial biofilms under different conditions displaying the potent efficacy of CPC (350 µg/mL) when combined with an artificial protein pellicle (Biotene half strength).
... Current treatments for CADS include the use of topical antifungal agents repeatedly applied to both the mucosa and the denture surface, but the re-infection rate is extremely high. Regular professional oral care, including simply removing dentures at night and leaving them to dry in the air, results in a decrease in the number of positive Candida cultures as well as a decrease in oral mucosal inflammation [14]. Moreover, incorporating professional oral care, including denture hygiene, resulted in a lower incidence of pneumonia, and a decrease in the number of febrile days in this frail population [15]. ...
Biofilms play a crucial role in the development of Candida-associated denture stomatitis. Inhibition of microbial adhesion to PMMA and phosphate containing PMMA has been examined in this work. C. albicans and mixed salivary microbial biofilms were compared on naked and salivary pre-conditioned PMMA surfaces in the presence or absence of antimicrobials (cetyl pyridinium chloride [CPC], KSL-W, histatin 5 [his 5]). Polymers with varying amounts of phosphate (0-25%) were tested using four C. albicans oral isolates as well as mixed salivary bacteria and 24 h biofilms were assessed for metabolic activity and confirmed using Live/Dead staining and confocal microscopy. Biofilm metabolism was reduced as phosphate density increased (15%: P=0.004; 25%: P=0.001). Loading of CPC on 15% phosphated disks showed a substantial decrease (P=0.001) in biofilm metabolism in the presence or absence of a salivary pellicle. Salivary pellicle on uncharged PMMA enhanced the antimicrobial activity of CPC only. CPC also demonstrated remarkable antimicrobial activity on mixed salivary bacterial biofilms under different conditions displaying the potent efficacy of CPC (350 µg/ml) when combined with an artificial protein pellicle (Biotene half strength).
... The commonest and highest bacteria isolated on CD wearers are Staphylococcus aureus (S. aureus) with a colonization of up to 66.7% and Streptococcus mutans (S. mutans) up to 73.3% [5]. Although various medications are used to treat DS, such as nystatin and miconazole, in a systemic or topic induction [6] but do not prevent the recolonization of bacteria and candida in CD wearers with poor oral hygiene [7,8]. A wide range of chemical disinfectants are recommended as decontaminants or cleansers of dentures [9]. ...
This research has several purposes: First to assess the bacterial and fungal minimum inhibitory concentration of Origanum Syriacum essential oil. Second to quantify its bactericidal and fungicidal minimal concentration against S. aureus, S. mutans, and C. albicans found in denture stomatitis. The third purpose is to look at the influence of three different soils (Annaya, Bhanin and Michrif) on the essential oils composition. Three essential oils were extracted by hydro-distillation from three different Origanum Syriacum plant origins. Bioassays were conducted using a broth microdilution methods. Gas Chromatography analysis was used to calculate the abundance of most components in each essential oil. Post hoc tests assessed antimicrobial effects between ecotypes while Pearson’s test correlated the different components and their antimicrobial efficiency (α < 0.05). All tested essential oils were efficient against all microorganisms. Origanum Syriacum essential oils derived from Annaya and Bhanin soils showed a superior antimicrobial activity compared to the Michrif one. The most abundant component and most efficient among all essential oils constituents was carvacrol. It can be concluded that Origanum Syriacum essential oils have an antimicrobial activity, which depends on the ecotype, its origin and its composition. They might be used to start a clinical trial for the treatment of denture stomatitis.
... 13 Along with the overall and potentially opportunistic microbial load that may have considerable impact on stomatitis development, [14][15][16] additional colonization with various other Candida species [17][18][19] may contribute to DRS increase, and this would seem intensified by high Candida growth numbers; 20 on the other side, an already established DRS would seem susceptible to favor Candida col-PROSTHODONTICS onization. 19 Besides nutritional status, 21,22 diabetes, [23][24][25] and smoking, 26-28 concomitant decline of the immune system, 29 reduced salivary flow (mouth dryness), 30 and allergic reactions, 31 other factors related to dental prostheses such as poor denture hygiene/denture cleanliness, 12,32,33 nightlong wearing, 22,34,35 poor retention or reduced occlusal vertical dimension, 36,37 use of denture adhesives and liners, 38,39 as well as the material of the denture itself 10,36,40 or simply denture age (with increased roughness, inadequate hygiene, and accumulation of plaque) 5,33,41 may support the onset of DRS. Table 1 compiles the known risk factors having been assessed over the last 10 years. ...
Objectives:
To assess the relationship between the development of denture-related stomatitis (DRS) and the identification of commonly isolated yeast species, and to evaluate various predisposing factors in Saudi participants wearing new removable dental prostheses.
Method and materials:
A total of 75 edentulous male participants were recruited, and 64 patients finished the present case-series. All participants received new conventional complete dentures. Colonization of Candida species was assessed, and species were identified by means of the VITEK 2 (bioMérieux) laboratory components.
Results:
The most prevalent type of Candida at baseline was C albicans, followed by non-C albicans species (C glabrata). Counts of Candida species significantly increased from the day of insertion to the first month (P < . 05), but there were no significant changes between the first and second month (P > . 05). On the day of insertion, C tropicalis, C dubliniensis, and C krusei were extracted from few subjects only, with no significant changes over the first and second month (P > .05). Patients revealing habits of sleeping with their dentures were found to frequently suffer from DRS; development of the latter was rapid, and mixed Candida biofilms (with high CFU/mL counts), along with inadequate oral and denture hygiene, turned out to be contributing factors (P < .05).
Conclusion:
DRS can develop faster than previously reported, even with new dentures; continued denture wearing and poor cleaning of dentures revealed a considerable impact on DRS onset. In the present cohort, C albicans was the most identified kind of yeast, and was followed by C glabrata infection in cases with DRS.
... Furthermore, patients wearing removable dentures at night were more likely to develop pneumonia than those removing it before bedtime [109]. The dentists' current recommendation is to remove dentures at night to prevent oral candidiasis promoting bacterial superinfection and to keep them dry or in a disinfectant bath [110][111][112]. ...
The article "Pneumonia prevention in the elderly patients: the other sides" written by Najla Chebib, Clémence Cuvelier, Astrid Malézieux-Picard.
... Furthermore, patients wearing removable dentures at night were more likely to develop pneumonia than those removing it before bedtime [109]. The dentists' current recommendation is to remove dentures at night to prevent oral candidiasis promoting bacterial superinfection and to keep them dry or in a disinfectant bath [110][111][112]. ...
Pneumonia is one of the leading causes of morbidity and mortality from infection in elderly patients. The increased frequency of pneumonia among elderly subjects can be explained by the physiological changes linked to the progressive aging of the respiratory tree and the diminished immunological response. A spiral of event leads to frailty, infection and possible death; preventing pneumonia consists of controlling the risk factors. Dysphagia, which is associated with malnutrition and dehydration, is recognized as one of the major pathophysiological mechanism leading to pneumonia and its screening is crucial for the pneumonia risk assessment. The impairment in the oropharyngeal reflexes results in stagnation of foreign material in the lateral cavities of the pharynx which may then get aspirated repeatedly in the lungs and cause pneumonia. Pneumonia prevention starts with lifestyle modifications such as alcohol and tobacco cessation. A careful review of the risk-benefit of the prescribed medication is critical and adaptation may be required in elders with multiple morbidities. Respiratory physiotherapy and mobilization improve the functional status and hence may help reduce the risk of pneumonia. Maintaining teeth and masticatory efficiency is important if malnutrition and its consequences are to be avoided. Daily oral hygiene and regular professional removal of oral biofilm can prevent the onset of periodontitis and can avoid an oral environment favoring the colonization of respiratory pathogens than can then be aspirated into the lungs.
... Maxillary denture wearers are more susceptible to Candida infections because the denture base serves as an effective reservoir harboring microorganisms. Low salivary flow rates, low buffering capacities, and low pH values under dentures contributeto colonization of the oral mucosa and denture surfaces by Candida [7][8][9][10][11][12]. Development of pathogenesis is preceded by the initial attachment of Candida on the palatal mucosa and mucosal surface of the denture. ...
Hybrid materials, which consist of organic-inorganic materials, are of profound interest owing to their unexpected synergistically derived properties. Aluminium oxide (Al 2 O 3) nanoparticles/polymer composites have been produced using a one-system polymer synthesis. The linear polymer, poly (methyl methacrylate) (PMMA, MW = 15,000 g/mol) and polymethacrylic acid (PMAA) are applied for the stabilization of Al 2 O 3 nanoparticles. The Fourier transfer infrared (FT-IR) analysis data and scanning electron microscopy (SEM) image reveal that the core shell structure of Al 2 O 3 /PMMA or Al 2 O 3 /PMMA/PMAA nanocomposites have been synthesized. The ratio of concentration of the capping polymer material to the concentration of the Al 2 O 3 precursor could control the size of Al 2 O 3 nanoparticles. With specific concentration of the reductant, the core-shell nanostructure could be fluctuated in order.
... Although it has been proven that Candida spp. colonization is affected by hygiene habits [38], some studies also did not find a correlation between amount of dental biofilm or gingival status with the presence of subgingival yeasts [30,39]. ...
Objectives:
The aim of this cross-sectional observational study was to compare the prevalence of different oral Candida spp. in patients with Type 2 Diabetes and chronic periodontitis in two oral sites: dorsal surface of the tongue and subgingival area. In order to determine subgingival areas as potential reservoirs of yeasts, this study aimed to find differences in the yeasts' detection between the dorsum of the tongue, as the oral site most commonly inhabited with microorganisms, and subgingival samples. Additionally, potential predictors for the yeasts prevalence were determined.
Material and methods:
Subjects (N = 146) were divided into four groups: group A- healthy individuals without periodontitis, group B- healthy individuals with chronic periodontitis, group C- Type 2 Diabetes patients with good glycoregulation and Chronic periodontitis and group D- Type 2 Diabetes patients with poor glycoregulation and Chronic periodontitis. Samples were obtained from the tongue by swabbing. Subgingival plaque samples were taken by paper points and periodontal curette. Isolation and identification of different Candida spp. was done using ChromAgar medium. In addition, germ-tube production and carbohydrate assimilation tests were performed.
Results:
The prevalence of Candida spp. was higher in diabetics with poor glycoregulation. The most frequently isolated species was Candida albicans followed by Candida glabrata and Candida tropicalis. In 15.6% of cases, Candida spp. was present in the subgingival area while absent on the tongue. Multivariate regression model showed that HbA1c was Candida spp. predictor for both locations.
Conclusions:
Our results confirmed that there are Candida spp. carriers among subjects with clinically healthy oral mucosa. Also, this study identified subgingival areas as potential reservoirs of these pathogenic species. Glycoregulation has been recognized as a positive predictor factor of Candida spp.
... Oral candidiasis has several predisposing factors, including systemic diseases that affect the immune status of the host, the local oral mucosal environment, and the specific strain of C. albicans implicated (Chi et al., 2010). (Budtz-Jørgensen et al., 2000, Maza et al., 2002, Ruissen et al., 2002, Torres et al., 2002. ...
Improved oral hygiene plays a vital role on quality of health and well-being of diabetic
patients. Poor oral health leads to an increased incidence of oral diseases, particularly
oral candidiasis. The emergence and global spread of azole- resistant Candida species
has necessitated the need for novel, cost effective antifungals to stop further spread of
resistant Candida infections.
This project is the first documented investigation of Candida species prevalence in
Libyan type 2 diabetes mellitus (T2DM) patients and investigated the antifungal effect
of Salvadora persica and Euclea natalensis on azole-resistant Candida isolates. In this
study, 182 Candida isolates from the oral mucosa of T2DM patients were identified
using presumptive species identification by chromogenic media followed by
confirmation using API ID 32 C, YST Vitek 2 and phenotype microarrays. Their drug
susceptibility profiles were tested using the disk diffusion and the AST Vitek 2
compact system.
High-pressure liquid chromatography and nuclear magnetic resonance were employed
to separate, isolate, and purify the bioactive compounds and fractions of the plant
extracts which were then tested for their antifungal activity. The results showed that
both Salvadora persica and Euclea natalensis promise to provide beneficial
alternatives to conventional drugs in treating oral candidiasis in diabetic patients.
... About 50 to 70% of complete denture wearers present a pathogenic state known as denture stomatitis. 1 This pathology is an inflammatory process characterized by homogeneous erythema or red focal areas, especially in the palatal mucosa and usually associated with Candida species, particularly Candida albicans. 2 Stomatitis represents a challenge for the dental field, and methods for the prevention of denture stomatitis, such as the incorporation of antimicrobial agents into polymers used as denture base and as tissue conditioners, have been developed. In contrast, silver (Ag) has been widely used in medical and life-care polymers and exhibits antimicrobial action. ...
Aim:
Silver colloidal nanoparticles have been incorporated into acrylic resins to induce antimicrobial properties. However, as additives, they can influence the mechanical properties of the final product. Mechanical properties are also dependent on different curing cycles. The aim of this study was to evaluate flexural strength of a denture base resin incorporated with different concentrations of silver colloidal nanoparticles subjected to two different curing cycles.
Materials and methods:
Lucitone 199 denture base resin was used into which silver colloidal nanoparticles were incorporated at 0.5 and 5% by polymer mass. Specimens devoid of nanoparticles were used as controls. A total of 60 specimens were fabricated and divided into two groups. Each group was divided into three subgroups consisting of 10 specimens each. The specimens were fabricated according to American Dental Association (ADA) specification No. 12 and tested for flexural strength using universal testing machine.
Results:
Silver colloidal nanoparticle incorporation at 0.5% concentration increased the mean flexural strength in both curing cycles by 7.5 and 4.4%, respectively, when compared with the control group.
Conclusion:
The study suggested that the mean flexural strength value of 0.5% silver colloidal nanoparticles in denture base resin was above the value of the control group both in short and long curing cycles, which makes it clinically suitable as a denture base material. However, at 5% concentration, the statistically significant amount of decrease in flexural strength compared with the value of control group both in short and long curing cycles gives it a questionable prognosis.
Clinical significance:
The specimens incorporated with the antimicrobial agent 0.5% silver colloidal nanoparticles and processed by long curing cycles showed significant increase in its flexural strength compared with the control group, which makes it clinically suitable as a denture base material.
... Cândida albicans, sendo a espécie mais encontrada em relação às demais em pacientes usuários de próteses dentárias acrílicas 6 , que são fator predisponente para a colonização por Candida. Outros aspectos que influenciam na colonização são higiene bucal e das próteses e o comportamento do micro-organismo 2,3,8,11 . ...
Candida albicans is the species most commonly found in relation to other species in patients
users of acrylic denture. Colonization by species of the genus Candida are commonly
associated with denture stomatitis. The aim of this study was to isolate, quantify and identify
species of the genus Candida in saliva samples in conventional denture and fixed dentures
on implants users. It was collected 20 ml of unstimulated saliva of systemically healthy volunteers.
100 μ of each saliva sample were seeded separately in the middle Sabouraud Agar
chloramphenicol dextrose (Difco) and Chromagar. After the incubation period the counting
of Colony Forming Units (CFU) was performed. The colonies were transferred to tubes containing
Sabouraud Dextrose broth, for later identification. In the conventional denture user
group two species were found: Candida albicans (50%) and Candida tropicalis (50%), in the
fixed dentures on implants user group were found the C. tropicalis species (70%) and C.
krusei (30%). In conclusion: microorganisms of Candida genus are present in the saliva of
conventional and fixed denture on implants users.
... The expression of C. albicans genes differ according to the C. albicans form. Candida hyphae are known to be essential to pathogenicity and disease dissemination, [6][7][8] and several hyphae-specific genes are known, including hwp1, als3, als8, ece1, and sap4-6. [9][10][11] The yeast-specific genes include rbe1, ywp1, and rhd1, and filament formation inhibiting genes include tup1 and nrg1. ...
Purpose
Candida albicans (C. albicans) and Proteus species are causative agents in a variety of opportunistic nosocomial infections, and their ability to form biofilms is known to be a virulence factor. In this study, the influence of co-cultivation with Proteus vulgaris (P. vulgaris) and Proteus mirabilis (P. mirabilis) on C. albicans biofilm formation and its underlying mechanisms were examined.
Materials and Methods
XTT reduction assays were adopted to measure biofilm formation, and viable colony counts were performed to quantify yeast growth. Real-time reverse transcriptase polymerase chain reaction was used to evaluate the expression of yeast-specific genes (rhd1 and rbe1), filament formation inhibiting genes (tup1 and nrg1), and hyphae-related genes (als3, ece1, hwp1, and sap5).
Results
Candida biofilm formation was markedly inhibited by treatment with either living or heat-killed P. vulgaris and P. mirabilis. Proteus-cultured supernatant also inhibited Candida biofilm formation. Likewise, treatment with live P. vulgaris or P. mirabilis or with Proteus-cultured supernatant decreased expression of hyphae-related C. albicans genes, while the expression of yeast-specific genes and the filament formation inhibiting genes of C. albicans were increased. Heat-killed P. vulgaris and P. mirabilis treatment, however, did not affect the expression of C. albicans morphology-related genes.
Conclusion
These results suggest that secretory products from P. vulgaris and P. mirabilis regulate the expression of genes related to morphologic changes in C. albicans such that transition from the yeast form to the hyphal form can be inhibited.
... Oral healthcare education of caregivers resulted in improved daily oral care for nursing home residents 20 . Oral healthcare programmes including both professional care and caregiver instruction in long-term care facilities demonstrated reduction in oral disease 21 . ...
Oral healthcare systems (OHCS) are designed to maintain the health and function through Communication (Health promotion and education), Prevention, Assessment and Diagnosis, and Treatment. The complexity of these OHCS functions for the ageing are described utilizing the spectrum of dependency of the Seattle Care Pathway framework. Barriers and disparities which challenge the development of OHCS for the ageing can be universal but often vary between developed and developing countries. Recognizing that oral diseases are largely preventable, strategies to improve OHCS must be targeted locally, nationally, and internationally at oral health policy, education, research, and clinical care.
... Approximately 70% of patients may suffer from denture stomatitis 1-3 , mostly associated with Candida albicans (C. albicans) 4,5 . It has been reported that oral bacteria readily adhere to the surfaces of dentures due to their rough surfaces and hydrophobic properties. ...
Poly-methyl methacrylate (PMMA)-based dental resins with strong and long-lasting antifungal properties are critical for the prevention of denture stomatitis. This study evaluated the antifungal effects on Candida albicans ATCC90028, the cytotoxicity toward human dental pulp cells (HDPCs), and the mechanical properties of a silver bromide/cationic polymer nano-composite (AgBr/NPVP)-modified PMMA-based dental resin. AgBr/NPVP was added to the PMMA resin at 0.1, 0.2, and 0.3 wt%, and PMMA resin without AgBr/NPVP served as the control. Fungal growth was inhibited on the AgBr/NPVP-modified PMMA resin compared to the control (P < 0.05), and the antifungal activity increased as the incorporation of the AgBr/NPVP antimicrobial composite increased. Confocal laser scanning microscopy (CLSM) showed that the number of fungal cells attached to the modified PMMA resin was considerably lower than in the control. The relative growth rate of HDPCs of modified groups were higher than 75%. The flexural strength (FS) and flexural modulus (FM) were not significantly different (P > 0.05) between the experimental and control groups. These data indicate that the incorporation of AgBr/NPVP conferred strong and long-lasting antifungal effects against Candida albicans to the PMMA resin, and it has low toxicity toward HDPCs, and its mechanical properties were not significantly affected.
... Cleanliness of the dentures is of paramount importance to prevent oral diseases among denture wearers. 17,18 For effective cleansing of the denture, it is critical to remove plaque (biofilm) not only from the polished surfaces of the prosthesis but more importantly, the tissue fitting surface. 19 There are several physical and chemical techniques for removing biofilms from dentures and the use of chemical solutions is one of the effective methods of improving denture hygiene. ...
... Another key result is the adhering filaments for Candida albicans, frequently encountered bacteria in the mouth of elderly patients with different acrylic prosthetics. In this case, are aimed the situations in which it is possible to counteract these trends with microbial resistant structures [20][21][22][23][24][25][26][27][28][29][30][31][32]. Candida albicans and other bacteriological agents have negative effects on acrylates that adheres because of its filamentary structure, contributing significantly to degradation of acr ylic material, so identifying and individualization possibilities for non-adhering materials is very important [33,34]. ...
The work is part of a larger study, representing second note, being focused on the correlation between the behaviour of polymeric materials as such or as copolymers from the group of methyl methacrylate, maleic anhydride and silicone rubber, reinforced or not with polyethylene fiber and metallic copper mesh with antifungal activity for 12 matrix polymer systems used in removable prosthesis and the final, respectively.
... Moreover, dental prosthesis also favours colonization of oral mucosa and dentures by Candida spp. [28]. However, other clinical conditions, such as easy bleeding gums suggestive of gingivitis, moving teeth indicating periodontal disease, edentulous mouth or recent history of a gumboil were unrelated to CAP. ...
Meat and its derivatives occupy a place of choice in our diet due to the nutritional quality of its proteins.
Among the processed meat products, the Kebab.
The objective of our study was to evaluate the hygienic quality of the kebab marketed in Mascara, to
analyze on the physicochemical and microbiological plan of the various samples in the 3 stages of
production of kebab (white meat, marinade and cooked dish of kebab). Thus to initiate to the traceability
by the application of Ishikawa diagram (5M).
To this end, six samples of kebab representing three stages of its manufacture were studied. All samples
were evaluated from a microbiological point of view (total aerobic mesophilic flora, total coliforms,
Staphylococcus spp., Clostridium sulphite-reducer, Salmonella, yeasts and moulds, Escherichia coli,
Campylobacter) and from a physicochemical point of view (pH, total dry extract, ash).
The results obtained reveal that microbiologically the Kebab marketed at the point of sale studied is
contaminated by a high rate of total aerobic mesophilic flora and by some pathogenic bacteria such as:
Campylobacter hyointestinalis, C. coli and C. jejuni, so the quality of the kebab is not considered to be in
accordance with the approved standards. However, from a physicochemical point of view, all the
parameters studied are satisfactory. As far as traceability is concerned, we consider it to be satisfactory
because the history of our product is known, especially as regards the labelling of the white meat used.
Consequently, it is strongly recommended that increased surveillance be carried out through rigorous and
regular control of this sensitive material throughout the year.
Key words: Kebab, microbiological analysis, Campylobacter, Meat, poultry.
Medicinal plant extracts are commonly applied for infectious diseases and are perceived as alternatives to conventional antimicrobial agents. We aimed to confirm the efficacy of phytotherapy for denture stomatitis compared with conventional therapies and placebo. A comprehensive literature search was conducted in Pubmed, Embase, Cochrane Library (CENTRAL), Scopus, and Web of Science, in addition to manual searching. Randomized controlled trials (RCTs) published in English, and studying the treatment of denture stomatitis with herbal medicines, were included. The outcome measures included the relief of clinical signs, reduced Candida colony counts, adverse effects, and patient satisfaction. Nineteen RCTs were included for a systematic review based on selection criteria. Two of them were analyzed using a random‐effects model. There was no difference in the relief of clinical signs (odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.43–2.15) and microbiological improvement (OR = 1.74; 95% CI: 0.55–5.45) between propolis and miconazole. Most of the included studies showed that phytomedicines had fewer side effects and more patient satisfaction than antifungals or disinfectants. However, further RCTs with more standardly prepared herbal formulations are required to verify the clinical efficacy of phytotherapy as an alternative or adjunctive therapy for denture stomatitis.
Background
For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence‐based supported oral care intervention is essential for this patient group.
Objectives
To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke.
Search methods
We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions.
Selection criteria
We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke‐specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life.
Data collection and analysis
Two review authors independently screened abstracts and full‐text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta‐analyses. We used GRADE to assess the quality of evidence for each outcome.
Main results
Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria.
OHC interventions compared with usual care
Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care.
Multi‐component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS –0.66, 95% CI –1.40 to 0.09; 2 trials, 83 participants; I2 = 83%; P = 0.08; very low‐quality evidence).
Stroke survivors had less plaque on their dentures when staff had access to the multi‐component OHC intervention (DMS –1.31, 95% CI –1.96 to –0.66; 1 trial, 38 participants; P < 0.0001; low‐quality evidence).
There was no evidence of a difference in gingivitis (DMS –0.60, 95% CI –1.66 to 0.45; 2 trials, 83 participants; I2 = 93%; P = 0.26: very low‐quality evidence) or denture‐induced stomatitis (DMS –0.33, 95% CI –0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low‐quality evidence) among participants receiving the multi‐component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi‐component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low‐quality evidence).
OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I2 = 94%; P = 0.03; very low‐quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I2 = 65%; P = 0.06; very low‐quality evidence).
OHC interventions compared with placebo
Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I2 = 42%; P = 0.07; low‐quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone‐iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77).
One OHC intervention compared with another OHC intervention
Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi‐component OHC intervention compared with conventional OHC interventions at three months (MD –0.04, 95% CI –0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low‐quality evidence). There were no data for denture plaque.
Authors' conclusions
We found low‐ to very low‐quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low‐quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta‐analyses to be low or very low quality, and this limits our confidence in the results. We still lack high‐quality evidence of the optimal approach to providing OHC to people after stroke.
Introduction:
the prevalence of denture related mucosa lesions (DRML) varies across different countries and a recent study reported an increasing trend in its prevalence. The objective of this study was to determine the prevalence of DRML and factors related to the lesions among denture wearers seen in a Nigerian teaching hospital.
Methods:
interviewer's administered questionnaire was used to obtain information from consecutive patients that had used removable denture for at least six months and consented to participate. Data related to gender, age, types of denture and presence of denture induced oral lesions were obtained, entered into a computer and analyzed using IBM SPSS Version 20. Descriptive statistics were expressed as frequency and percentages. Fisher's exact test was performed for discrete variables. A P-value less than 0.05 was regarded as statistically significant.
Results:
a total of 104 respondents participated in the study and 14 had DRML giving a prevalence of 13.5%. The majority, 11 out of the 14 (78.57%) presented with mucosa ulceration, while 8 (57.14%) out of the 14 cases of DRML were caused by over extension of the denture flanges. There was no statistically significant relationship between daily removal of denture fore going to bed to sleep at night and DRML (p=0.776).
Conclusion:
the prevalence of denture related mucosal lesion was 13.3% and the major cause was over extension of denture flange. There is need to emphasize adherence to review appointments for early detection and correction of denture instability and over extension of denture flange to prevent DRML.
Objective:
To investigate associated risk factors for oral candidiasis in elderly patients hospitalized in a community-based acute-care hospital with no dental units.
Methods:
Two hundred and twenty-eight elderly patients (male: 105, female: 123), who were hospitalized with several systemic diseases in a community-based acute-care hospital from May 2014 to October 2016, were retrospectively analysed by multiple logistic regression.
Results:
Multiple logistic regression analysis shows that bacterial pneumonia has a statistically strong relationship with oral candidiasis (p = 0.000, OR: 5.173, 95% CI: 2.368-11.298). The order followed is poor oral hygiene (p = 0.001, OR: 6.095, 95% CI: 2.003-18.545) and severe dry mouth (p = 0.043, OR: 2.507, 95% CI: 1.031-6.098). Other correlated factors including diabetes mellitus, denture wearer, dysphagia, malnutrition, requiring care and use of inhalation steroids, were not statistically significant in this study.
Conclusions:
Bacterial pneumonia correlates with oral candidiasis.
Objectives:
Older people are at increased risk of intraoral yeast colonization. In this observational case series, we assessed Candida colonization among nine nursing home residents to investigate possible correlations with their individual characteristics, general health parameters, and oral care. We also described the effect of professional dental cleaning (PDC) including prosthesis cleaning on colonization cases.
Materials and methods:
General clinical and oral health was assessed in nine residents, and samples were taken from six oral mucosa sites or prosthetic surfaces. PDC was performed to achieve macroscopically clean results, and residents were re-examined 2 weeks later.
Results:
We found that six residents were intraorally colonized with Candida albicans; four also had Candida glabrata. Prostheses were particularly infected. Dementia, multimorbidity, and presence of prostheses reduced oral hygiene ability; requiring assistance for oral hygiene care was a risk indicator for Candida colonization. PDC reduced C. albicans (at the expense of increased C. glabrata) but was not optimal for maintaining Candida reduction.
Conclusion:
In this pilot study, Candida colonization is prevalent among nursing home residents, especially those with cognitive impairment, multimorbidity, or reduced oral hygiene capacity. Potential negative effects on general health necessitate diagnostic and therapeutic guidelines. PDC alone did not maintain the reduction in Candida colonization; additional methods for daily oral care are necessary.
Background:
Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013.
Objectives:
1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists).
Search methods:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
Selection criteria:
Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials.
Data collection and analysis:
Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach.
Main results:
We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I2 = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence).
Authors' conclusions:
For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.
La population vieillit et ainsi, de plus en plus de personnes âgées sont institutionnalisées. Les résidents des EHPAD présentent une santé bucco-dentaire inquiétante mais surtout une hygiène bucco-dentaire insuffisante, ce qui en fait une des priorités de santé publique.Nous avons réalisé une étude auprès des personnes âgées dépendantes et autonomes de la maison de retraite de Dommartin-sur-Vraine, afin de décrire leur état de santé bucco-dentaire et d'évaluer leurs besoins en soins, ainsi qu'une enquête auprès du personnel soignant de l'établissement afin d'évaluer leurs compétences en matière d'hygiène bucco-dentaire.Les résultats de ce travail ont montré la relation entre résidents, personnel soignant et chirurgien-dentiste. Il apparaît aussi la nécessité d'établir une organisation des soins buccodentairesdans ces institutions de long séjour, d'une formation tant théorique que pratique dupersonnel soignant, ainsi que d'une coordination entre tous les acteurs de santé (personnel soignant, gériatres, chirurgien-dentiste) et le résident.
In the coming decades the western world will experience a double ageing of its population; there will be an increase in both the number of older people and the average age. The increase in life expectancy will also mean more and more older people who suffer from multiple systemic diseases that are treated with medications. At this moment, 45% of those over 65 use 5 or more medications and 20% of those over 75 use as many as 10 or more. The more medications used, the greater the risk of side effects and therefore oral side effects, like symptoms of dry mouth or the development of candidiasis, angioedema, gingival hyperplasia, lichenoid reaction of the oral mucosa, dysgeusia, halitosis and osteonecrosis. Considering the wide range of oral side effects, it is important for dentists to be well aware of the medications being used by older patients as well as having a thorough knowledge of their oral side effects.
Denture stomatitis is a chronic inflammation of the denture bearing mucosa. This pathology is difficult to control by denture wearing patients. The disease envolves different predisposing factors, the most important of them being the presence of Candida. This article describes the management of these patients and the difficulties of the present treatments in eliminating the fungal remnants from the prosthesis and the oral mucosa. It is concluded that the oral and personal hygiene habits are the most important methods to prevent this pathology in denture wearing patients. If the pathology is already established, we can control these patients by means of hygiene measures and antifungal agents, but we have to be aware of the therapeutic limits in presence of Candida deposits on the prostheses. In some cases, replacement of the prosthesis may be indicated.
Background:
Associations between nursing home residents' oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents' oral health.
Objectives:
To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents.
Search methods:
We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases.
Selection criteria:
Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention.
Data collection and analysis:
Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information.
Main results:
We included nine RCTs involving 3253 nursing home residents in this review; seven of these trials used cluster randomisation. The mean resident age ranged from 78 to 86 years across studies, and most participants were women (more than 66% in all studies). The proportion of residents with dental protheses ranged from 62% to 87%, and the proportion of edentulous residents ranged from 32% to 90% across studies.Eight studies compared educational interventions with information and practical components versus (optimised) usual care, while the ninth study compared educational interventions with information only versus usual care. All interventions included educational sessions on oral health for nursing staff (five trials) or for both staff and residents (four trials), and used more than one active component. Follow-up of included studies ranged from three months to five years.No study showed overall low risk of bias. Four studies had a high risk of bias, and the other five studies were at unclear risk of bias.None of the trials assessed our predefined primary outcomes 'oral health' and 'oral health-related quality of life'. All trials assessed our third primary outcome, 'dental or denture plaque'. Meta-analyses showed no evidence of a difference between interventions and usual care for dental plaque (mean difference -0.04, 95% confidence interval (CI) -0.26 to 0.17; six trials; 437 participants; low quality evidence) or denture plaque (standardised mean difference -0.60, 95% CI -1.25 to 0.05; five trials; 816 participants; low quality evidence). None of the studies assessed adverse events of the intervention.
Authors' conclusions:
We found insufficient evidence to draw robust conclusions about the effects of oral health educational interventions for nursing home staff and residents. We did not find evidence of meaningful effects of educational interventions on any measure of residents' oral health; however, the quality of the available evidence is low. More adequately powered and high-quality studies using relevant outcome measures are needed.
Objective:
The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: INCLUSION CRITERIA: This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to:1 quantify the oral health status of older adults living in residential aged care facilities;2 quantify the oral health status of adults with dementia living in the community and in residential aged care facilities;3 evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities;4 evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and5 evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities.Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics.
Search strategy:
The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents.
Methodological quality:
All selected studies were critically appraised by two reviewers prior to inclusion in the review.
Results:
In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions.
Conclusions:
This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.
Aims and objectivesTo investigate the perspectives of nursing home caregivers towards oral care and the determinants of their attitudes and perceived behavioural control. Background
There are few studies analysing nursing home caregivers' perspectives on the provision of oral care and factors correlated with these perspectives. DesignCross-sectional study. Methods
Interviewer-administered survey questionnaires were completed by caregivers from five nursing homes in Singapore (n=94). The rating-scale questionnaire items explored caregivers' attitudes, subjective norms and perceived behavioural control, as guided by the theory of planned behaviour. Demographic characteristics, oral care training received, years of work experience, oral hygiene behaviour and dental visit frequency of the caregivers, as well as organisational characteristics such as a requirement for oral care and the number of patients under their care, were obtained. ResultsCaregivers had very positive attitudes towards the provision of oral care. Half of the caregivers lacked confidence in providing oral care without harming the patients and this was not different by oral care training received. Multivariable linear regression analysis found that receiving oral care training and having a requirement by the nursing home to provide oral care were related to higher attitude scores but not perceived behaviour control. Having more residents under their care and on-the-job caregiver training were associated with lower perceived behavioural control. Conclusions
This study found that nursing home caregivers had positive attitudes towards providing oral care, but more modest perspectives about their ability to perform that behaviour. Relevance to clinical practiceThese findings have useful implications for the oral care training of nursing home caregivers. While attitudes towards the importance of oral care may be positive among nursing home caregivers, our study suggests that future interventions should include practical skills training for oral care management and consider organisational strategies for encouraging oral care provision.
Denture stomatitis is a common inflammatory condition affecting the mucosa underlying complete dentures. It is associated with denture microbial biofilm, poor denture hygiene, poor denture quality, and nocturnal denture use. Numerous treatment methodologies have been used to treat stomatitis; however, a gold standard treatment has not been identified. The aim of this systematic review is to report on the current knowledge available in studies representing a range of evidence on the treatment of denture stomatitis.
This is the protocol for a review and there is no abstract. The objectives are as follows:
To assess the effects of oral health educational interventions for nursing home staff and residents to maintain or improve the oral health of nursing home residents.
To describe the components of the complex interventions used in the included studies.
Adequate oral health is an essential part of general health in all age groups, but in particular in older age groups. Good oral health is a prerequisite to physical, mental and social wellbeing and quality of life. Adequate and accessible oral health service is a fundamental right of “all” vulnerable older people living in a community. This doctoral thesis demonstrates inadequate oral health and oral health care delivery in institutionalised older people and concerns the development and application of an oral health care model for older people in nursing homes emphasizing the integration of oral health care into daily care.
Changes in knowledge and practice of 30 dietitians in Israel who work in geriatric care were assessed following a training program on nutrition-focused physical assessment (NFPA) of the oral cavity. Knowledge scores increased from pre- to immediate posttraining (P < .001), to 12 months posttraining (P < .001), and from immediately to 12 months posttraining (P = .015). For all NFPA components at 3 months posttraining, participants were more likely to perform the assessment themselves rather than avoid the assessment for that component or obtain the data from the medical record. From 3 to 6 months posttraining, there were no significant changes in the proportion of "performed" assessment components; performance of assessment components was retained over time.
Good denture care practice by individuals using Removable Partial Denture (RPD) is an important component of oral health measures. An assessment of denture care practice of such individuals by dental care practitioners is necessary.
To evaluate the denture care practice among prosthetics patients attending a tertiary Hospital Dental Centre in Nigeria.
An interviewer administered questionnaire was used to obtain information from RPD wearers that were willing to participate. The questionnaire assessed among other things, patients' bio-data, frequency, techniques and device used for cleaning their dentures. Data was analyzed using Chi-square test (P < 0.05).
One hundred and ninety eight denture wearers consisting of 100 (50.5%) males and 98 (49.5%) females participated in the study. Majority 110 (55.6%) cleaned their dentures once daily and toothbrush and pastes were used by 105 (53%) of the participants. More than 70% of the respondents removed their dentures at night. One hundred and sixty-six (83.8%) visited the dentist only when they needed treatment. There was a statistical significant relationship between frequency and technique of cleaning denture, and denture cleanliness (P < 0.05).
This study shows that once daily cleaning of dentures and cleaning the denture with rest of the teeth are ineffective in prevention of plaque accumulation.
A double-blind trial was carried out to study the effect of oral administration of fluconazole in the treatment of Candida-associated denture stomatitis. The study group consisted of 38 denture stomatitis patients who harbored yeasts, predominantly Candida spp., in significant numbers as determined by culture from the lesions. Half of the patients received 50 mg of fluconazole per day orally for 14 days, and the other half received placebo capsules. The following parameters were studied: degree of palatal erythema, presence of yeast cells (by plate count and microscopy of smears), identification to the species level of dominant yeast organisms, biotyping of Candida albicans, and treatment-related side effects. A significant reduction of erythema was seen after treatment with fluconazole, but the inflammation showed partial relapse 2 to 4 weeks after treatment was terminated. Reduced soreness of the oral mucosa was reported by six of the patients in the fluconazole group. No significant clinical or yeast flora changes were observed in the placebo group. Extensive changes in the yeast flora were observed in the fluconazole group, both in quantity and in composition of yeast species and C. albicans strains (biotypes), which perhaps indicated differences in pathogenicity and fluconazole susceptibility among various yeast species and C. albicans strains. Fluconazole did not produce any changes in the results of blood and urine analyses. The results indicate that fluconazole is a safe and well-tolerated antimycotic drug. The transient clinical and antimycotic effect may have been due in part to the possibility that therapeutic concentrations of the drug were not reached beneath the fitting denture surface and within the denture plaque.
CHROMagar Candida is a new differential culture medium that allows selective isolation of yeasts and simultaneously identifies colonies of Candida albicans, C. tropicalis, and C. krusei. We evaluated the use of this medium with 316 yeast isolates including 247 isolated directly on CHROMagar from clinical material. Over 95% of stock and clinical isolates of C. albicans, C. tropicalis, and C. krusei were correctly identified on the basis of colony morphology and pigmentation on CHROMagar. Additionally, CHROMagar also allowed the identification of C. (Torulopsis) glabrata at a similar level of accuracy. The overall agreement between two observers in reading the CHROMagar plates was 95%. Growth of Candida sp. isolates on CHROMagar had no adverse effect on antifungal MICs or Vitek identification results. In parallel, cultures of 548 stool and rectal swab specimens set up on CHROMagar and Sabouraud glucose agar (SGA) were positive in 234 instances. CHROMagar was positive and SGA was negative for 11 specimens, and CHROMagar was negative and SGA was positive for 18 specimens. A single yeast species was isolated on both media from 162 specimens, and in 146 (90%) of these specimens the same species was detected on both CHROMagar and SGA. A total of 43 of the 234 positive cultures contained mixtures of yeast species. Twenty (47%) of these mixed cultures were detected only on CHROMagar. CHROMagar is extremely useful in making a rapid presumptive identification of common yeast species. This capability plus the ability to detect mixed cultures of Candida spp. promises to improve and streamline the work flow in the mycology and clinical microbiology laboratory.
The efficacy of a topically administered miconazole denture lacquer was compared with that of a placebo lacquer in the treatment of Candida-infected denture stomatitis. The study was a double-blind, randomized, controlled clinical trial with two parallel treatment groups. The lacquer was applied once on the fitting denture surface. Follow-up examinations took place on days 3, 7, 14, 21, 28, and 35. On day 14 the effect of the treatment was assessed. Thirty-six patients were included in the statistical analysis. Eighteen received miconazole and 18 received placebo lacquer. Primary efficacy endpoints were the number of colonies cultured from the palatal mucosa and denture surface on day 14. Thirteen of 16 patients in the miconazole group A showed < 10 colonies on culture medium on day 14 in the specimens from the palatal mucosa as did 5 of 18 patients in the placebo group B (p < 0.05). Corresponding results for the denture surface were 6 of 17 and 3 of 18, respectively (p < 0.05). Reapplication of lacquer was considered necessary (> 100 colonies in at least one sampling site within 14 days) in 35% of the patients from group A and in 83% of the patients from group B. The results indicate that a single application of a miconazole denture lacquer considerably reduces the number of Candida yeasts for a substantial period of time.
Proper hygienic care of removable dentures is an important means of maintaining a healthy oral mucosa in denture wearers. Denture cleanliness is often poor due to improper mechanical cleansing and the relative inefficiency of most commercial products for chemical cleansing of dentures. Dentists and patients should realize that microbial plaque on dentures may be harmful to both the oral mucosa and the patient's general health. It is the responsibility of the patient to maintain oral hygiene through a daily home care routine. It is the obligation of the dentist to motivate and instruct the patient and provide the means and methods for plaque control. Future research should be directed to developing solution cleansers which can maintain plaque-free dentures with a daily soaking period of 15 to 30 minutes and not affect the color and surface luster of the denture acrylic resin.
It was the purpose of the study to test the efficacy of dissolvent tablets containing mutanase and protease in removing denture plaque. The study group consisted of forty institutionalized geriatric denture wearers, who were assigned randomly into an enzyme group and a placebo group. Enzyme tablets and placebo for denture soaking were administered by the nurses. The dentures were immersed for 15 min once daily for three months. The amount of denture plaque, the clinical condition of the palatal mucosa, and the concentration of yeasts and bacteria in mucosal and denture smears were recorded before, during, and after the experimental period. The study was designed and carried out as a double-blind study. After denture soaking for six weeks a significant reduction of the amount of denture plaque and improvement of the clinical condition of the palatal mucosa was recorded. After denture soaking for twelve weeks the conditions had improved further when comparing the enzyme group with the placebo group.
It was the purpose of the study to test the efficacy of brushing with a 1% chlorhexidine gel or a commercial solution cleanser (Steradent) in preventing formation of plaque on the fitting surface of new dentures. The study group consisted of 74 denture wearers with denture stomatitis who were assigned randomly to one of four treatment groups, testing either the chlorhexidine gel, a placebo gel, Steradent, or a placebo solution. The experiment was started immediately after denture treatment was completed. The experimental period was 1 month. The amount of denture plaque, the clinical condition of the palatal mucosa, and the concentration of yeasts in mucosal and denture smears were recorded while the patients used their original dentures and after the experimental period. Plaque had formed on all new dentures but to a smaller extent in the groups testing the chlorhexidine gel or the placebo gel. The study does not provide any obvious evidence of a chemical effect of chlorhexidine gel or Steradent as a means to prevent formation of microbial plaque on the mucosal surface of maxillary complete dentures.
An investigation was undertaken of 77 denture wearers to study the incidence of yeasts in the angles of the mouth, denturebearing mucosa, denture base, the throat and the gastrointestinal tract. Fifty-one denture wearers exhibited denture stomatitis and 26 showed no clinical signs of inflammation of the palatal mucosa (controls). In addition the influence of oral local treatment with an antifungal agent (Mycostatin®) on the yeast flora in the same sites was studied in denture wearers with denture stomatitis. The findings suggest a higher rate of yeast colonization in the mouth (100% compared to 40%) and feces (71% compared to 35%) in denture wearers with denture stomatitis than in denture wearers without stomatitis. Similar species of yeasts, predominantly Candida albicans, C. tropicalis and Torulopsis glabrata were identified among the isolates from the oral sites, throat and feces in denture wearers with stomatitis. In denture wearers without stomatitis the yeast species isolated from the oral sites and feces differed. In these samples the saprophytic yeasts Saccaromyces and Rhodutorula together with T. glabrata were dominating. Fourteen days of local oral treatment with Mycostatin significantly reduced the number of positive cultures of yeasts from the oral sites and the stool samples. However, after cessation of treatment the mycotic flora was largely re-established in most subjects.
Biopsy materials from the palatal mucosa showed no invasive fungal elements. All persisting yeast isolates after fourteen days treatment were susceptibility-tested and found to be sensitive to nystatin.
In 100 patients with denture stomatitis cultures and direct smears were used to evaluate 5 treatments, including sucking of chlorhexidine, amphotericin B or placebo tablets combined with denture soaking in 0.2% chlorhexidine or water. After 14 days of treatment the amphotericin B lozenges had brought about a significant reduction in the quantity of fungus on the oral mucosa, whereas they barely affected the large amount present on the fitting surface of the upper denture. Denture immersion in chlorhexidine significantly reduced the number of organisms both on the mucous membrane and on the denture. It therefore seems at least as important to treat the denture as the patient in denture stomatitis. Fourteen days after withdrawal of the drugs the mycotic flora was largely re-established.
The purpose of this study has been to assess the prevalence of denture stomatitis and candida infection in an elderly Danish population. Ten percent of the population above the age of 65 in a Danish community was selected randomly. The study group consisted of 465 persons wearing a removable maxillary denture, who were examined in their homes. Yeasts were isolated by oral swabs for cultivation and by mucosal and denture scrapings for microscopy. The prevalence of denture stomatitis was 65%. Yeasts, especially C. albicans, were cultivated in most denture wearers with denture stomatitis (Group 1) or with clinically normal palatal mucosa (Group 2). However, large accumulations of hyphae were present in 77% of the patients in Group 1 compared with 47% in Group 2; both hyphae and inflammatory cells were seen in smears in 65% of Group 1 but only in 14% of Group 2. On the other hand, bacterial contamination of the smears was more pronounced in Group 2 than in Group 1. The study has revealed that candida infection and poor denture cleanliness are very common in elderly denture wearers.
This paper outlines the main findings of an exploratory study into carers' attitudes towards looking after the oral hygiene needs of their elderly patients and relatives. The data were collected using eight group discussions covering a cross-section of carers and carer settings throughout central Scotland. A range of barriers to improving levels of care was identified. The paper concluded that to make positive progress, a comprehensive oral hygiene programme is required to break down these barriers. It is believed that a strong educational policy based upon carers' needs should form the main impetus of such a programme.
Root caries prevalence was recorded for a consecutive sample of dental patients (n = 146), aged over 55 yr and with at least 12 natural teeth. The mean root DFS score of the males (n = 49) was 6.34 +/- 4.55 and for the females (n = 97) 3.76 +/- 3.31 (P less than 0.001). The salivary levels of mutans streptococci, lactobacilli, and yeasts were determined in addition to salivary flow rate and buffering capacity. Subjects with greater than 1 root DFS had significantly higher salivary levels of mutans streptococci, lactobacilli, and yeasts. They also had fewer teeth and more exposed root surfaces. In step-wise multivariate analyses the factors significantly related to the root DFS score were the number of exposed root surfaces, number of teeth, sex and salivary yeast levels (R2 = 0.41). In the multivariate analyses salivary levels of mutans streptococci were not significantly related to any clinical measurement of root caries experience due to the greater strength of association between the root DFS score and salivary levels of yeasts. Subjects prescribed medicines with a reported xerostomic effect had significantly fewer active root lesions than those not prescribed such medicines and salivary levels of all microorganisms studied were significantly elevated in subjects prescribed medications containing sucrose.
A total of 137 patients in long term hospital care were interviewed and examined to determine the prevalence, nature and most important causes of oral candidosis in the hospitalized elderly. Oral candidal infection as determined by the imprint culture technique was present in 47% of patients with a further 31% being carriers of Candida. The prevalence of chronic atrophic candidosis in denture wearers was 38%, while 26% of all patients had angular cheilitis, 67% of which had an infective etiology. Microbiologic examination strongly indicated the upper denture as the major source of infection in those with dentures despite the existence of a ward policy which should have encouraged good oral and denture hygiene.
The number of immunocompromised patients has increased during recent years. Most fungal infections in these patients are caused by Candida, Aspergillus, Mucor, and Cryptococcus species. Patients with low granulocyte count are at the highest risk of invasive candidal infection. The commonest type of granulocytopenia is observed in connection with malignant diseases of the hematopoietic system. Cytotoxic treatment and radiotherapy of large-body areas tend to produce a significant decrease in circulating granulocytes. Early diagnosis and adequate treatment of fungal infections are mandatory for a successful outcome. In the oral cavity it is important to differentiate between colonization and invasive infection. The optimal approach to diagnosis is a combination of histology and cultivation of specimens obtained from the same site of suspected infection. Prophylaxis of oral fungal infection in immunocompromised patients is generally aimed at preventing colonization.
By tradition oral candidosis has been classified into acute pseudomembranous (thrush), acute atrophic, chronic atrophic, and chronic hyperplastic types. However, pseudomembranous candidosis is not always acute but may last for many months. Furthermore, the value of using the term atrophic to describe an erythematous area is limited. Moreover, some of the various types have been associated with other clinical entities, which appear to have a combined bacterial/mycologic etiology. A revision of the classification should be based on the use of clinical terms, and in a previous study of multifocal oral candidosis, erythematous, plaque-like, and nodular forms were identified. A revised classification of oral candidosis which considers these aspects could be as follows: acute types: pseudomembranous and erythematous; chronic types: pseudomembranous, erythematous, plaque-like, and nodular; and Candida-associated lesions: denture stomatitis, angular cheilitis, and median rhomboid glossitis.
Yeasts occur commonly in the oral cavity in healthy individuals. The prevalent species is Candida albicans (about 60-70% of all isolates). C. glabrata and C. tropicalis come next, followed by other Candida species and genera (Rhodotorula, Saccharomyces, etc.) which are all of rare occurrence and transient. The yeast flora increases in many patient groups, especially those who are immunocompromised. C. albicans is the most important species, being the cause of almost all cases of yeast infections in the region, often in association with other species. The number isolated from the oral cavity depends on testing site and methods used. C. albicans can be typed by means of serology (types A and B), by biotyping, by morphology, by means of sensitivity to killer factors, by electrophoretic karyotyping, DNA fragments, and immunoblotting. Such methods may be of value epidemiologically. Switching in Candida morphology is associated with changes in micromorphology and physiology. Several non-yeast fungi may affect the oral cavity, most frequently in association with lung or disseminated infections.
The purpose of this study was to evaluate a comprehensive, on-site, oral health care program for nursing home residents. Before and after a 1-year evaluation period the elderly residents in the nursing home (NH-1) were interviewed and examined clinically. A comparable control group comprising the elderly residents in another nursing home (NH-2) were also interviewed and clinically examined before and after a 1-year period. The main objectives of the program were to increase the utilization of the dental care system, to meet the need for immediate attention, to improve oral hygiene, to reduce the prevalence of oral mucosal lesions, gingivitis, and untreated decay, and to meet the realistic prosthodontic treatment need. All the elderly residents accepted a yearly examination by a dentist, and 50% were treated in NH-1 during the evaluation period, compared with 16% in NH-2. The need for immediate attention was reduced by 56% in NH-1 and had increased by 20% in NH-2. Whether the activities in NH-2 qualify as an oral health program with on-site examinations and referral for treatment outside the institution is discussed. The annual cost per resident during the evaluation period was a little more in NH-2 than in NH-1. The conclusion is that oral health improved during the observation period in both nursing homes. The rate of participation and the improvement in oral health was most evident in NH-1.
In the United States elderly persons are the least likely of any age group to utilize dental services. With the increase in the elderly population and expansion of interest in their dental care, our understanding of the barriers to that care is particularly important. Studies have indicated that cost of treatment, fear of dentistry, functional independence and poor general health are of little significance in explaining the low utilization patterns of this age group. Perceived need seems to be the strongest predictor in deciding whether dental services are sought by an individual. Two programmes established by The University of Washington aimed to enhance the utilization of dental services by the elderly. One provided free screenings for over 65's on low incomes, coupled with a low cost dental care scheme. Although it was found that the convenient location of a dental clinic was a valuable incentive for the increased uptake of services, the difficulty remained one of patient perception of need. The second programme sought to overcome this latter problem by providing information on the importance of oral health to the independent elderly. This included a weekly class for small groups conducted by a health educator over a 6-week period together with a self-monitoring chart for each participant. It is anticipated that the heightened awareness aroused by this education programme will translate into perceived need and thus greater dental service utilization by the participants.
The purpose of the study was to determine the prevalence of oral mucosal lesions among institutionalized elderly. The study population comprised 486 elderly from eight nursing homes, and 199 elderly from five hospital long-term care facilities in the eastern part of Denmark. Approximately half of the subjects exhibited one or more pathologic conditions of the oral mucosa. Denture related traumatic ulcerations were found in 3.9% of the nursing home residents, compared to 8.3% among the elderly in hospital long-term care. The most prevalent finding was denture stomatitis, which was manifest in about one third of the elderly. The prevalence was strongly influenced by the denture hygiene; 54% of the elderly with poor denture hygiene suffered from denture stomatitis, as compared to only 7% of those with clean dentures. The prevalence of denture stomatitis was also related to the usage of dentures at night and to the age of the dentures. The prevalence decreased significantly with increasing age, although the oldest age group did not have better denture hygiene, or more favorable wearing habits. It did not appear that sex, type of residency, degree of urbanization, denture conditions, or the use of anticholinergic drugs influenced the prevalence of denture stomatitis. The prevalence and severity of the disease can probably be reduced if the denture hygiene is improved and if the elderly only use their dentures during the daytime.(ABSTRACT TRUNCATED AT 250 WORDS)
Patients wearing complete dentures are generally advised to remove the dentures from the mouth at night, and to store them in water. The use of immersion cleansers is also some times recommended.Generally patients are told to prevent acrylic dentures from drying out as it is suggested that they will undergo dimensional change.This study demonstrates that if acrylic dentures are left to dry in air for 8 hours then the density of the Candida colonization is significantly reduced. The dimensional changes in the acrylic resin specimens tested was so small that this would not have any significance clinically.It is suggested therefore, that when treating denture stomatitis the regime of allowing the maxillary denture to dry overnight could be used as a simple adjunct to treatment regimes.
A dental health survey of 233 elderly people in the Halton Health Authority was undertaken. Elderly subjects were chosen from different residential groups so that comparisons could be made and those most in need identified.Only 28 subjects (12 per cent) had any natural teeth remaining: of these 16 wore no denture at all.Assessed need was much greater than that perceived by the subject. Seventy-four per cent of the sample were found to need replacement dentures and 40·6 per cent had a mucosal or pathological lesion: people resident in the community with no assistance were those most likely to have a lesion (68 per cent). Thirty per cent of the sample were prevented from attending for treatment by problems of cost or mobility, and 30 per cent had not visited a dentist in the last 21 years.Suggestions are made for improvements in existing dental provision for the elderly, and education of the public at large, those caring for the elderly, and of the profession itself so that improved services may be provided in the future.
Of 36 patients, 17 had oral leukoplakia, including homogeneous and nonhomogeneous types, and 19 had reticular lesions of oral lichen planus. A sample of yeast flora in each patient was taken from the pathologic lesion as well as from normal-appearing mucosa. The isolated yeasts were identified according to species level, and identification was extended beyond the species level for one species, Candida albicans, to reveal the biotype by means of the Odds and Abbott procedure comprising tests for acid and salt tolerance, proteinase production, resistance to 5-fluorocytosine and safranine, and assimilation of urea, sorbose, and citrate. Yeasts were present in the lesions of 82% of leukoplakia patients, compared to 37% of lichen planus patients, a frequency of yeasts corresponding to that in healthy adults. C. albicans was the dominating species in lesions of both diseases, constituting 82% of all yeasts in the leukoplakia lesions. In addition, the following species were identified: Candida tropicalis, Candida pintolopesii, Torulopsis glabrata, and Saccharomyces cerevisiae. Eighteen biotypes of C. albicans were encountered, the most frequently occurring biotypes being 355 and 177. Differences between C. albicans biotypes isolated from pathologic and normal mucosa were encountered in five of eleven leukoplakia patients and in one of three lichen planus patients. This indicates that the oral cavity comprises several ecologic niches for yeasts. As nonhomogeneous leukoplakias are more likely to develop into carcinoma than are homogeneous leukoplakias, it is interesting to note that the C. albicans biotypes isolated from nodular lesions (one type of nonhomogeneous leukoplakia)--biotypes 145, 175, and 575--rarely occur.(ABSTRACT TRUNCATED AT 250 WORDS)
The validity of a simplified diagnostic aid, Oricult-N, for detection of oral candidoses was compared with smears stained according to the periodic acid-Schiff's method. Samples were taken from 80 locations in 36 patients with lesions suspected for candidal infection. There was a statistically significant correlation between the two methods (P less than 0.001).
abstract – In a double-blind study conducted on 53 wearers of complete dentures, application of 2 % chlorhexidine gluconate to the fitting surface of the maxillary denture for 2 weeks was found to produce a significant amelioration of inflamed tissues beneath the denture. Mycelium was eliminated in 90 % of the patients, as evaluated by palatal smears. Five weeks after the treatment was terminated the candida infection of the palatal mucosa was re-established in all but one of the patients, probably because disinfection of the maxillary denture did not effect a complete suppression of candida growth, neither in the palate nor in other sites of the oral cavity. It is concluded that chlorhexidine gluconate is an appropriate alternative to specific antimycotic drugs for the treatment of palatal can didiasis. However, until conclusive evidence has been produced that prolonged mouth-rinsing with chlorhexidine is biologically acceptable, it should be used primarily as a denture disinfectant, whereas specific antimycotic drugs should be used to eradicate candida residing on the oral mucosa.
Candida induced denture stomatitis usually does not reflect any deep seated abnormality, the dentures being the primary predisposing condition. However, infection with C. albicans should be recognized as an extremely common complication to the wearing of complete or partial dentures. Most cases are easily treated, but recurrences are frequent, and the infection often spreads to involve other parts of the oral mucosa, such as the tongue and the angles of the mouth. Therefore, preventive measures should be taken against colonization by Candida species of the palatal mucosa and the dentures. Patients with denture stomatitis offer an outstanding opportunity to study host parasite relationships in candidiasis in otherwise healthy individuals. In addition, the experimental model for induction of superficial candidiasis in monkeys makes it possible to study development of immunologic competence under various conditions. Although mycelium is seen consistently in smears, most abundantly in denture smears, tissue invasion is not recognized either in acquired or in experimental palatal candidiasis. It is most likely that Candida species exert their pathogenic effects partly through an enzymatic breakdown of the epithelial surface and partly by eliciting a delayed hypersensitive response, Candida endotoxins may aggravate the lesions.
All 352 patients in two nursing-homes in Orebro were examined. In one of the homes microbiological tests could be done on the patients with full upper dentures. The samples were taken both from the denture and the oral mucosa. Candida albicans, Yeast, Staph. aureus, B-hemolytic streptococci and Klebsiella/Enterobacter were controlled. In samples from the oral mucosa a correlation was found between stomatitis, Candida albicans and Staph. aureus (P less than 0.01). A weak correlation was also found between stomatitis and Klebsiella/Enterobacter (0.01 less than P less than 0.05). In samples from the dentures there were only a weaker correlation between Stomatitis, Candida albicans and Staph. aureus (0.1 less than P less than 0.05).
Comprehensive oral health care is an essential feature of quality of life. In the near future, a greater number of elderly people will retain more natural teeth, whether or not supplemented by prosthetic provisions, and/or may be provided with implants. As a consequence, oral self-care will be much more demanding. Prevention must reduce the greater risk of oral disease for elderly people. Effective early intervention strategies are: promotion of over-all general health, obviation of stereotypes, education by dental hygienists, instruction and demonstration combined with systematic evaluation, use of a fluoride containing dentifrice, and regular professional support and use of chlorhexidine rinses for less well and confused elderly.
An open randomized controlled study involving two parallel treatment groups comprising 50 patients with Candida-associated denture stomatitis was performed to evaluate the efficacy and safety of one application of 1 g of miconazole 55 mg/g denture lacquer in comparison with that of a commercially available miconazole 2% gel applied four times daily for 2 weeks. The results showed a pronounced reduction in the yeast scores and a reduction in the palatal erythema in both treatment groups, but there was no apparent difference between the efficacy of the two treatments. The results indicate that a single application of the denture lacquer (55 mg of miconazole) is safe and almost as effective as administration of gel four times a day for 2 weeks (3000 mg of miconazole).
Zusammenfassung. Es wurde eine offene, randomisierte, kontrollierte Studie mit zwei parallelen Behandlungsgruppen, die 50 Patienten mit Candida-assoziierter Prothesenstomatitis umfaßten, zur Bewertung der Wirksamkeit und Sicherheit der Einmalanwendung von 1 g Miconazol-Prothesen-Lack (55 mg Miconazol/g) im Vergleich zum kommerziell erhältlichen 2%igen Miconazol-Gel bei täglich viermaliger Anwendung über zwei Wochen hinweg durchgeführt. Als Ergebnis zeigte sich eine deutliche Reduktion der Hefekeimzahlen und ein Rückgang des palatalen Erythems in beiden Behandlungsgruppen, jedoch war zwischen den Gruppen kein Unterschied zu erkennen. Die Ergebnisse belegen, daß die Einmalanwendung des Prothesen-Lacks (55 mg Miconazol) sicher und so wirksam ist wie die Gelanwendung viermal täglich über zwei Wochen (3000 mg Miconazol).
A chewing gum containing the antifungal drug miconazole may be convenient for topical treatment of oral candidosis. Therefore a trial was performed to examine the effect and tolerance of miconazole chewing gum in comparison with miconazole gel in the treatment of oral candidosis. The study group consisted of 32 patients with oral candidosis harboring yeasts, predominantly Candida spp. Half of the patients chewed one piece of chewing gum (dose: 3.6 mg of miconazole) four times daily; the other half dispersed a 2% gel (dose: 50 mg of miconazole) in the oral cavity four times daily. After 6 wk of treatment, there was no clinical evidence of yeast infection in either of the two groups. No significant differences between the two groups were found in clinical, mycologic, and cytologic investigations conducted after 3 and 6 wk of treatment or at the follow-up examination 4 wk after termination of the treatment. The results indicate that miconazole released from chewing gum is as effective as miconazole gel. The chewing gum reduced the dosage of miconazole for treatment of oral candidosis, and the patients approved the chewing gum as a pleasant medicament.
To obtain information on the oral health status of the elderly living in a medicalized, geriatric institution.
A cross-sectional clinical investigation with complementary microbiological studies.
A cohort of 233 elderly in one long-term care ward; collection of demographic data; clinical examination to determine dental and prosthetic status and health of the oral mucosae; swabs for detection of mucosal and denture colonization by Candida; paraffin stimulated saliva for detection of colonization by mutans streptococci and lactobacilli.
Oral and denture hygiene; oral mucosal health; degree of colonization by Candida, mutans streptococci and lactobacilli.
Mean age of the 233 patients was 85.6 +/- 6.9 years; 61% were totally dependent, 62.7% were wearing one or two complete dentures; 19.7% had natural teeth and no denture and 17.6% neither teeth nor denture. Of those wearing dentures 72% had denture stomatitis. Of those with natural teeth 72% were affected by active caries. Yeast counts were significantly correlated with the intensity of the erythema of the palatal mucosa, plaque score of the natural teeth, denture plaque score, and salivary counts of mutans streptococci and lactobacilli.
High oral yeast counts and frequent prevalence of oral candidosis in elderly subjects living in institutions are associated with poor oral hygiene and neglect of denture care.
This study was designed to investigate the reported dental attendance and the perceived barriers to dental care for frail and functionally dependent older adults.
A single centre study of a housebound group of more than 60 years of age and their personal carers.
The study was carried out from a general dental practice in Ware, Hertfordshire, a market town 20 miles north of London.
A group of 263 housebound adults more than 60 years old were identified. The subjects were living in 5 residential homes, 3 sheltered housing complexes and in private accommodation. The subjects and 115 of their personal carers were interviewed.
93% only attended a dentist when they had problems. The presence of natural teeth, residential status and age were all statistically significant independent explanatory variables for the time since the previous reported dental visit. Lack of perceived need was found to be a barrier to care for 86% of subjects. Cost and lack of suitable transport were also commonly identified. However, the true cost implication to a patient was poorly appreciated especially by those 34% of subjects who cited cost as a barrier. 52% of the whole group, rising with age to 75% of those more than 90 years old, expressed a preference for treatment to be carried out in their own homes. 93% of carers had found difficulty in arranging dental care for their clients but the difficulties were not always the same as the subjects' perceived barriers. Among the carers, younger, regular dental attendees who were paid to care were more likely to see benefit in obtaining dental care for their clients.
The mechanisms by which these barriers to care may be lowered should be investigated in order to meet the unmet need identified by this study.
The aim of this study was to evaluate clinically and microbiologically the effects of a preventive oral health program in a long-term care facility. A total of 116 dentate elderly residents agreed to participate, and half of them were included in an experimental group. Almost all of the residents were mentally or physically handicapped, and many were dependent on care-givers for daily living activities. Oral examination and microbiological sampling were performed at baseline and 18 months later. The experimental group benefited from a preventive program, including an oral hygiene course for the health care providers and regular recalls by dental hygienists of the residents. After 18 months, the plaque indices were statistically similar to those at baseline in both groups. Mutans streptococci counts and active root caries at 18 months were lower compared to baseline in the experimental group but did not change significantly in the control group. Thus, it seems that, while the preventive program failed to decrease plaque indices, it was effective in reducing mutans streptococci colonisation and caries prevalence.
The aim of this study was to evaluate the influence of an oral health education program (OHEP) on attitudes among the responsible nursing personnel toward performing oral health procedures for care receivers. A total of 2882 nursing personnel were offered participation in the OHEP, and the effect was evaluated by means of a questionnaire distributed pre-educationally as well as 1-2 months post-educationally. The nursing personnel were allocated, on the basis of nursing education, to either a "high level of health care education" group (HHCE), including registered and enrolled nurses, or a "low level of health care education" group (LHCE), including nursing assistants and home care aides. Statistical analysis was performed by means of descriptive and analytical statistics. After the OHEP, the nursing personnel estimated their ability to perform oral hygiene procedures for care receivers to be significantly increased. Post-educationally, a significant shift in importance was observed from knowledge regarding the diseased oral cavity to knowledge regarding the healthy oral cavity. It was also observed that, in the LHCE group, the OHEP favored practical procedures, while in the HHCE group, theoretical considerations were favored. This indicates that, when oral health education programs are designed, due attention should be paid to the nursing personnel's education level.