RESUMEN
Because oral health among residents of German nursing homes is inadequate, this intervention study evaluated the effects of dental training for nurses and nursing assistants (RN and RA) in homes for the elderly on their assessment of oral health in residents and, as a consequence, on the status of residents' oral health. 53 residents and the RNs and RAs from three homes for the elderly participated in this study. The nursing staff received training in dental health care. As primary outcome, the competence in performing the Brief Oral Health Examination (BOHSE) was measured at baseline date and four months after training. Additional outcome measures were dental and denture hygiene in residents, functional status of dentures, and treatment needs. Dental training was shown to improve the nursing staff's competences in oral health assessment in tendency. Residents' oral hygiene improved significantly, whereas no relevant effects on hygiene and functional status of dentures were registered. The need for dental treatment turned out to be considerable at both measurements. Modifications in test tools with identification of dental treatment needs seem to be indicated in order to improve cooperation between nursing staff and dentists in homes for the elderly.
Asunto(s)
Atención Odontológica/enfermería , Enfermería Geriátrica/educación , Higiene Bucal/enfermería , Anciano , Curriculum , Índice CPO , Estudios de Seguimiento , Alemania , Hogares para Ancianos , Humanos , Investigación en Educación de Enfermería , Casas de Salud , Índice de Higiene OralRESUMEN
The aim of this study was to determine whether associations exist between anterior edge-to-edge bite, anterior crossbite, deep bite and morphology of the temporomandibular joint (TMJ) in the vertical dimension, evaluated by magnetic resonance imaging (MRI) in adults. A total of 148 subjects (90 females, 58 males) were selected from the cross-sectional epidemiological population-based study "Study of Health in Pomerania" (SHIP) for this evaluation. In each person a clinical orthodontical examination was performed. Four linear measurements and one ratio from MRI scans of the TMJs were evaluated. To estimate the effects of anterior edge-to-edge bite, anterior crossbite and deep bite on TMJ variables, linear regression was applied. (Analyses were adjusted for sex, age, school education, and orthodontic treatment.) Anterior edge-to-edge-bite/crossbite had shorter mean eminence heights (eh) on both joint sides (p<0.01). In deep bite without gingival contact the postglenoid process height (pgph) decreased significantly in left joints (p=0.018) and there was a tendency to a decrease in right joints (p=0.059). The ratio between eminence height and postglenoid process height (eh/pgph) was increased on both left (p<0.001) and right (p=0.002) joints. In conclusion, anterior edge-to-edge-bite/crossbite is connected to a reduced eminence height and deep bite without gingival contact with an increased ratio between eminence height and postglenoid process height. Therefore the condylar path in the anterior edge-to-edge bite and crossbite cases can be interpreted to be reduced and in the deep bite cases without gingival contact to be steepened.
Asunto(s)
Imagen por Resonancia Magnética/estadística & datos numéricos , Maloclusión/epidemiología , Maloclusión/patología , Sobremordida/epidemiología , Sobremordida/patología , Trastornos de la Articulación Temporomandibular/epidemiología , Trastornos de la Articulación Temporomandibular/patología , Adulto , Anciano , Comorbilidad , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estadística como Asunto , Articulación Temporomandibular/patologíaRESUMEN
The purpose of this study was to determine risk indicators for the aetiology of abfractions (cervical wedge-shaped defects) on teeth using dental and medical variables obtained in a population-based sample of the cross-sectional epidemiological 'Study of Health in Pomerania' (SHIP). Medical history, dental, and sociodemographic parameters of 2707 representatively selected subjects 20-59 years of age with more than four natural teeth were checked for associations with the occurrence of abfractions using a two-level logistic regression model on a tooth and a subject level. The estimated prevalence of developing abfractions generally increased with age. The following independent variables were associated with the occurrence of abfractions: buccal recession of the gingiva, odds ratio (OR) = 6.7; occlusal wear facets of scores 1, 2 and 3, OR = 1.5, 1.9, 1.9; tilted teeth, OR = 1.4; inlays, OR = 1.6; toothbrushing behaviour, OR = 1.9 to 2.0 (two and three times a day versus once a day). First premolars had the highest estimated risk for developing abfractions, followed by the second premolars. Maxillary and mandibular teeth behaved similarly in terms of abfractions, with the exception of mandibular canines, which had a much lower estimated risk of incurring abfractions than did maxillary canines. The results of this analysis indicated that abfractions are associated with occlusal factors, like occlusal wear, inlay restorations, altered tooth position and tooth brushing behaviour. This study delivers further evidence for a multifactorial aetiology of abfractions.
Asunto(s)
Abrasión de los Dientes/etiología , Atrición Dental/etiología , Raíz del Diente , Adulto , Estudios Transversales , Oclusión Dental Traumática/complicaciones , Restauración Dental Permanente/efectos adversos , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Abrasión de los Dientes/epidemiología , Atrición Dental/epidemiología , Cepillado Dental/efectos adversosRESUMEN
BACKGROUND: In this study, risk determinants were determined for periodontal disease in the representative population sample (n=3146) of the Study of Health in Pomerania. METHODS: After examining the net random sample (response 69%) and exclusion of edentulous cases and those with missing values, 2595 subjects remained. Using a multivariate, fully adjusted logistic regression, different definitions of "periodontally diseased/healthy" were examined as the dependent variable (extent of attachment loss (AL> or =4 mm, combined AL and tooth loss). The independent variables used were sociodemographic factors (age, gender, income, education), medical factors (systemic diseases, drugs), behavioral factors (regular dental checkup, smoking), and oral factors (presence of supragingival calculus and plaque). RESULTS: The following risk determinants were found for AL: male gender, presence of supragingival plaque and calculus, smoking, low educational level. For the combination of AL and tooth loss, risk determinants were female gender, supragingival plaque, smoking, and low educational level. Consumption of antiallergic medications and regular dental checkups proved to be protective. Smoking was the most influential risk determinant. These parameters explained approximately 43-55% of the variation. CONCLUSION: These results concur with those of the literature. In order to explain disease status further, host-response and microbiological factors must also be examined.
Asunto(s)
Enfermedades Periodontales/epidemiología , Adulto , Anciano , Cálculos Dentales/epidemiología , Cálculos Dentales/etiología , Placa Dental/epidemiología , Placa Dental/etiología , Métodos Epidemiológicos , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/etiología , Fumar/epidemiologíaRESUMEN
The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18-71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological 'Study of Health in Pomerania' (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann-Whitney U-tests. Sixty per cent of the tinnitus patients and 36.5% of the control subjects exhibited more than two symptoms of TMD (P = 0.004). Tinnitus patients had significantly more muscle palpation pain (P < 0.001), temporomandibular joint (TMJ) palpation pain (P < 0.001), and pain upon mouth opening (P < 0.001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1.6 for one to three painful muscles and OR = 2.53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2.99), listlessness (OR = 2.0) and frequent headache (OR = 1.84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.
Asunto(s)
Trastornos de la Articulación Temporomandibular/complicaciones , Acúfeno/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Anciano , Enfermedad Crónica , Estudios Transversales , Femenino , Alemania/epidemiología , Pérdida Auditiva/complicaciones , Pérdida Auditiva/epidemiología , Humanos , Masculino , Músculos Masticadores/fisiopatología , Persona de Mediana Edad , Dolor/etiología , Distribución por Sexo , Estadísticas no Paramétricas , Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/epidemiología , Trastornos de la Articulación Temporomandibular/fisiopatología , Acúfeno/epidemiología , Acúfeno/fisiopatologíaRESUMEN
BACKGROUND: Periodontitis is a bacterial inflammatory disease leading to attachment loss with the consequence of tooth loss. There exists a multifactorial risk pattern including bacterial challenge, smoking, age, gender, diabetes, and socioeconomic and genetic factors. Smoking has the highest impact on the course of the disease modulated by all the other factors. Here, we report the relationship between smoking and the genetic polymorphism of interleukin-1 (IL-1). METHODS: In a randomly selected population-based study, we genotyped 1,085 test persons for the IL-1 genotype, examined their periodontal status, and assessed their smoking behavior including present and past quality and quantity of smoking. RESULTS: There was a significant dose-effect relationship between the exposure to tobacco smoke and the extent of periodontal disease assessed as attachment loss and tooth loss. Moreover, there was a gene-environmental interaction. Subjects bearing at least one copy of the variant allele 2 at positions IL-1A -889 and IL-1B +3954 (genotype positive) had an enhanced smoking-associated periodontitis risk as compared to their IL-1 genotype-negative counterparts. With genotype-negative non-smokers as a reference, logistic regression resulted in odds ratios of 0.98 (95% confidence interval: 0.83 to 1.14), 2.37 (1.96 to 2.87), and 4.50 (2.30 to 8.82) for genotype-positive non-smokers, genotype-negative smokers, and genotype-positive smokers, respectively. CONCLUSIONS: There is a gene-environmental interaction between smoking and the IL-1 genetic polymorphism. Smokers bearing the genotype-positive IL-1 allele combination have an increased risk of periodontitis. The IL-1 genotype has no influence in non-smokers.
Asunto(s)
Interleucina-1/genética , Periodontitis/inmunología , Polimorfismo Genético/genética , Fumar/fisiopatología , Adulto , Alelos , Intervalos de Confianza , Estudios Transversales , Femenino , Genotipo , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pérdida de la Inserción Periodontal/clasificación , Índice Periodontal , Periodontitis/genética , Factores de Riesgo , Humo/efectos adversos , Fumar/genética , Nicotiana/efectos adversos , Pérdida de Diente/clasificaciónRESUMEN
The aim of this longitudinal study was to analyze growth-related changes in untreated Class II, Division 1 subjects. Forty untreated Swedish children with Angle Class II, Division 1 malocclusion were cephalometrically examined. The average age of the total group was 10.1 years at the first examination and 12.0 at the second. In addition to statistical comparisons of the average values of variables at both time points, multivariate analyses (harmony box according to Hasund and Segner, regression equation analyses) were also performed. This permitted individual evaluation of skeletal structures, position of incisors, and the soft tissue profile relative to the given craniofacial configuration. With the ANB angle remaining unchanged, both jaws were transposed ventrally. The reduction of the angle between the palatal and mandibular planes and the gonial angle was accompanied by anterior rotation of the mandible. The lower incisors protruded, and upper and lower first molars exhibited a translation to ventrocaudal. According to harmony box analysis, the most frequent cause of a distal relationship between the 2 jaws was a disharmoniously anterior shift of the maxilla. This was confirmed by the additional analysis of the available unpublished raw data from untreated Norwegian and Munich Class II/1 subjects and from other studies. In such cases, orthodontic treatment methods exerting a growth-inhibitory effect on the maxilla should be used.
Asunto(s)
Maloclusión Clase II de Angle/fisiopatología , Desarrollo Maxilofacial , Envejecimiento , Cefalometría/estadística & datos numéricos , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Maloclusión Clase II de Angle/diagnóstico , Análisis Multivariante , Selección de Paciente , Caracteres Sexuales , SueciaRESUMEN
Using conventional comparisons of means and multivariate analyses, the aim of this study was to establish skeletal proportions and their growth-dependent development in untreated subjects with class II/1 malocclusion and compare them with a longitudinally-examined, untreated group with neutral occlusion. 138 untreated children from Nittedal/Norway with an Angle-class II/1 malocclusion were examined longitudinally using radiocephalometry at 2 points in time: average ages of 9.1 and 12.1 years. These class II/1 children were compared to a group of 80 untreated children with class I occlusion (also from Nittedal, similar age group). In addition to the Norwegian participants, untreated children with class II/1 malocclusion from Sweden and Germany were longitudinally analyzed. Besides a comparison of the mean values of the measured basal variables, a multivariate analysis was conducted with the help of graphically converted regression equations (harmony box). In comparison to the class-I children with neutral craniofacial pattern, the mandibles in children with class II/1 malocclusion showed a significant posterior shift at both points in time. According to evaluation with the harmony box, the craniofacial dimensions were harmonious in class I occlusion. In all class II/1 groups, the maxilla was located slightly disharmoniously to the anterior at both time points. The average basal alterations were relatively minor. If not only individual mean values are compared with one another, but also multivariate relations of the viscerocranium are considered, a maxillary anterior shift is more frequently diagnosed in subjects with a class II/1 malocclusion than is possible with a comparison of mean values.