Abstracts of prescntenations at the 6th Annual Conference of the EuropeanCollege of GerondontologyA joint meeting with the third European Congress of Gerontology inAmsterdam, 30 August - 2 September 1995

Dclccling llic medically compromised palicnt in dcniistry hy [he Medical1 Risk-Rdated-Hislory(MRRH).

EC, SMEETS, KJM DE JONG. L ABRAHAM-INPIJN (Dep GeneralPathology and Inlemal Medicine, ACTA. The Nclherlands.)

ObjectivesIn the Netherlands, medical problems of dental patients which can mlerfimj withdental treatment were registered. For this registration a patient-administeredMRRH was used.Study desinn50 selected lientisLs received a one-day introductory course that focused on thequestions in the Medical Risk-Related-History and accompanying ASA riskscores. Futhermore, dentists were asked to verbally verify the given answers; toinclude only patients over the age of 18 and to ask for informed consent.Results50 dentists were selected of which 45 panicipated; 5 withdrew at an early stage.29.424 Medical Risk Related Histories were submitted to analysis {male:52.1%,female: 46 i"a, unknown:!.6°o). The average age was 37.1 ± 13.5 years. Medi-cal problems were classified into difTcreni categones and their relation with agewas examined. The eonditions which increase with age were hypertension,cardiovascular-, neurological-, blood-, endocnnologic disease. According lo thecurrent guidelines, dental "treatment must be adjusted when a patient has anASA risk score III or IV. In this study, approximately 26"o of patients age 65-74and 37''.b of patients over 74 need special dental treatment. These figures form acontrast lo the approximately 6" D of patients aged 18-34.Cooclusion

For the general dental practice this means that taking a medical history isespecially important in the case of elderly patients. Their medical condition shouldbe taken into account in dental treatment and if necessary treatment should beadapted accordingly.

Ageing and saliva2 A. VISSINK',F.K.L SPIJKERVET' AND A, VAN NIHLW AMERONGEN'

('Department of Oral and Maxillofacial Surgery. University Hospital,Groningen and -Department of Oral Biochemistry, Free University,Amsterdam, The Netherlands)

It IS often assumed that salivary secretion reduces with age. About 25% of theelderly suffer from oral dryness and its related eomplaints. When considennghealthy elderly, however, analysis of data on salivary tlow rate revealed nosignificant decrease when compared to flow rate in healthy adolescents and adults.The assumed age-related decrease in salivary flow rate is thought to be related tosalivary gland pathology, systemic diseases and/or the patients medication.Although salivary flow rate is not reduced in healthy elderly, age-related changesin salivary gland morphology and consequently in the composition of salivahave been reported. When considenng salivary gland morphology, the numberof acini reduces and the amount of fatty and fibrous tissue increases with age.Moreover, animal studies revealed that the synthesis of proteins is reduced by60% at advanced years. These data indicate lhat. although the secretion of fluidand electrolytes appeared not to be related to ageing, changes might occur inconcentration and/or activity of the organic components of saliva. In humanstudies, no age-related ehanges were observed in the composition of parotid sa-liva, while the concentration of sIgA in labial saliva and the concentration ofhigh-molecuiar (MG-1) and low-molecular (MG-2) mucins in mucous salivaappeared to be strongly reduced with age. As slgA and MG-2 are important inthe immunologic and non-iminunologic defence of the oral cavity, respectively,both defences are reduced in healthy elderly. It can be concluded that, althoughthe loss of funclional parenchyma with age is compensated for by the reservecapacity of the salivar>' glands, the L>ral soft tissues may become somewhat moresusceptible to environmental factors due to a reduction of the immunologicaland non-immunological defence.

n Focusing on a new Target Group m DentistL. ABRAHAM-INPIJN (Department of Genera! Pathology and InternalMedicine. ACTA, Amsterdam, The Netherlands)

ObjectivesAsa result of the growing prosperity of the past 50 years, people have becomeincreasingly aware of the importance of 'quality of life'. And expectationscontinue to rise, even among those who have reached quite an advanced age.SubjectsOver 65 years of age: The physiological age change is gradual There is atendency to divide this population into 'the young elderly" (65-74) and 'theelderly (over 75), and the new elderly (45-65).

The existence of this medically compromised group of "new elderly' patientsnow seen in the dental practice is due lo:- the ageing of the dental population- increased demands on quality' of life- new possibilities m dentistry- the rise in the number of chronically ill patients who are socially active.ResultsThis socio economic group consisting of patients between 45 and 65 forms thenewest and most interesting population in dentistry.

There is a demand for higher-quality health care, whieh is reflected in theexponential rise in the number, of conservative treatments. These are oftenrequested by older patients with a more critical attitude towards the notion offull dentures. This population, which is hetter educated, will be demanding awider range of dental services than m the East These patients have greatereconomic security, hut their mean age is higher and, or the whole, the group isless healthy.

Age yrs MCP%New elderly 45-65 43Young elderly 65-74 48Elderly >75 61ConclusionTTiis marks the beginning of a crucial discussion centring on the responsibility'for the medically compromised patient in dentistry

Salivary secretion, masticatory performance and nutrition of medically•y compromised elders.

V. DORMENVAL', P. MOJON', A. BRUYERE', E. BUDTZ-J O R G E N S E N ' ('University of Geneva, DnHsion of Gerodontology andRemovable Prosthodontics and -Department of Geriatnc Medicine,Geneva, Switzerland)

Reduced salivary flow levels, feeling of oral dryness and protein energy malnu-trition are frequent complications in medically compromised eldersObjectiveTo study the relationship between whole salivary flow rate, eotnplaints of oraldryness and degree of malnutrition in non-psychiatric elderly patients.Study designAn inter\iew concerning symptoms of oral dryness was carried out beforecollection of saliva.SubjectsThere were 70 women and 30 men and the mean age was S3±4,3 years.Intervention and main outcome measuresWhole stimulated salivar\ flow rale (SSFR) and unstimulated salivary flow rate(USFR) (Sreebny 19*̂ 2) were measured twice. Serum albumin was determined24 h before or after estimation of salivary flow rates. The number of chewingstrokes of a biscuit and the time until first swallowing was determined.Results52% complained of oral dryness but only I7''o showed reduced USFR ( 0.1 ml'min) whereas 26.5" 0 showed reduced SSFR( 0.5 ml mini. The number of chew-ing strokes tended to be higher in patients with reduced SSFR (p<0.06). TheSSFR and USFR were significantly reduced in patients who eompiained of oraldryness (P=0.02). 40°o suftered from severe protein energy malnutrition (albu-min < 30 g/1) whereas 46Po of lhe patients showed moderate protein energymalnutrition (albumin 30-35 g/\). SSFR was signiHcantly lower in severelyprotein/energy malnourished patients (p<O.OI). There was no relationshipbetween number of medications and salivary How rates.ConclusionsProtein ni;ilnutrition seems to be a major problem among recently hospitalizedelders. The results suggest that the symptoms of oral dryness and the reducedsalivary flow rule observed were associated with malnutrition rather than being asecondary' effect of medication.

Volume 12, No. 2

12

c Impluiii-rvtiiincd ovcnlciiuirvs in i-ldcrly cJciiltiioiis [liitiL-ntsKALK, W. (Dcpurlmcnl ol" (.)riil I'unclioii mid Proslliclic DL-iilislryUniversity of Nijmcucn, The Ncllicrlands)

A hiph rail- ot"NUIII-SS IUIN been rvportod tor osscointcgnilcU impUinls Mippurimj: tiM-J pn>Mhcsi.-s iii cilcnUiloiis piiliciils, However, rcporls uboul iinpLint-a-luini-v) (m;iiidilHil(ir) nM-nlcnlures in elderly piiticnts iire sciircc. Moreover,iiuisl studies do mil ivCKm mi piiiuiiis wUli severe ;ilvei>lur hmie loss uiiil urclivii-seiJ on over.ill surMViil r.iics iit iiidividuiil inipl;ints Willi respect lo thee\alu;i(ion ol putienls' views siiine studies hiive been piihlishcd eoncennnginiplani-siippiirieil fixed (lUJTiJihiilnr) prostheses and iinplant-reliiinedo\erdi'niuni-s on specil'ii. implant-systems Uniil now ihere nrc few studies inwhich illOercnt implant-systems a'tiiiningtiverdenliires arc eompared, Tlie onlystudy design tliat enahlcs comparison of differeni iniplunl-systcms is a (phaseIII) mndomi7ed prospective clinical tnul,

A multicenierrandomi/e<J 'chniciil tnal in whieh treatment cITeclsofdilTcr-enl implant-systems and designs was evaluated. The uim of this mullieenterstudy wastoeonipare (he Irealmenl elTects ofimplant-retiiined overdenlurcs in(elderly) patients with se\ere alveolar bone loss, usiny dilTereiit iniplani-system;.. with a eontrol trcalment group receiving new conventional completedentures.

The results ol the elinieal outcomes as well as patient relaled aspcels will hediscussed and guidelines jiuen for designing implant-reiained overdentures inelderly edentulous patients

7 Preventive Prosihodonties.J F, McCORD (Unit of Prosthodontics, University of Manchester.England.)

The purpose of this presentation is to define prevention as it is applied toprosthdonlics and to review various methods whereby this philosophy may bepractised. In essence, preventive prosthodontics seeks to prevent latrogencsis,preserve both hard and soft tissues and to maintain and prolong acceptablefunction.

To achieve these stated aims, preventive regimes would involve no treat-ment, dietary advice and orul hygiene instruction, shortened dental arches,patient-friendly prostheses and bone-retaining agents. Clinicians must neveroverlook, however, the ability and motivation ofpatienLs to maintain oral healthThe rationale of bone-rctaining methods encompasses overdentures. ridgeaugmentation and dental implants The presentation is concluded by a reportof a scienufic evaluation of the use of mandibutar implants to serve as fixedprints for analysis of bony changes in the mandible. It is recommended thatthis technique affords a reliable method of measunng mandibular easts.

p The influence of aging on oral status^ R.L. ETTINGER (Dept. of Prosthodontics/Dows Institute for Dental

Research, University ot'lowa, USA)

The health and integnt\ ofthe oral mueosa is dependent on an intact mucosawhieh protects the tissue beneath it. Longitudinal studies have shown that thereare very few age-assoeiated changes but changes are accelerated by stress, bytrauma, by disease, and by the drugs used to treat these diseases. Neurosensorydecline in vision and tactile sensation resuiLs in a decline in the ability of anolder adult to maintain adequate oral home hygiene, whieh results in an in-crease in the plaque related diseases sueh as caries and periodontal diseaseUnlike skin, the oral mucosa in healthy persons appears to remain relativelyunchanged with age. The clinical aging often reported in the past are likely tobe related to the expression of systemic diseases, a poor nutritive state, and theoral side effects of various pharmacotherapies. The most commoD of these aresalivary dysfunction, lichenoid reaction, bleeding disorders and tissueovergrowth. These dysfunctions also predispose the tissue to a higher nsk ofbactenal infection, fungal infection, and the plaque related diseases. The major-ity of dental services for older persons in most countnes are provided in com-munity based offices. The bulk of oral health care for these older adults willcontinue to be reconstructive dental eare that is the restoration of teeth andfunction ofthe stomatognathic system with fixed and removable partial den-tures and now also implanLs. These restorative and reconstructive services arebecoming much more difficult and adequate restoration materials do not exist.The use of local anaesthetic requires the dentist to understand interaction ofthese drugs and the patient's health and medication. Therefore oral health careof the mucosa and the teeth requires the dentist to work as part of amultidisciplinary leam. if elderly persons are to receive the rational care theyneed.

10 Oral diseases in the elderly: Diagnosis and treatmentI. VAN DER WAAL (ACTA, University Hospital. Free Utiivcrsity of Am-sterdam, The Netherlands)

Oral diseases in the elderly are rather common but are not always properlydiagnosed. As a result, adequate treatment may be withheld On the other handproper treatment may be withheld erroneously, due to the old age ofthe patient.This IS particularly true in patients wjth oral cancer. A overview will he pre-sented ofthe most eommon benign and malignant lesions and conditions thatmay afTect the mouth of the elderly The emphasis wilt be on the diagnosis andtreatment.

g Pulmonary infection unJ oral health status in the very oldP MOJON. li, U U D I Z - J O K O B N S H N , PC. BAEI-INI, {Department ofGerodontology and Removable Proslhetics, University of Genevu.Switzerland)

ObjectivesIblook lor a relationship bei ween oral health status and the incidence of pulmo-nary inleitiiin in medically compromised ciders.Stud) di'sit;riI lie rcsideiils of u home were examined hy onu dentist and the la.st IH months ufilie medical records were reviewed.SubJL-cIs.̂ 12 medically compromised elders {72% female, mean age: 86 years, s.d.^ 7|were seen during the study[Vliiin Outcome Measures7hc episodes of hmncho-pulmonary infection and dental emergency treatmentwere recorded tor each resident. The Barthel Index of independence was used tocategorize subjects. The dental examination comprised an evaluation of oralhygiene (PI. Silness and Loe, l^W), quahiy of prosthetic appliances and thereeording of caries and penodontal as well as mucosal diseases {WHO, 1987),The subjects were then classified in two groups: those with latent emergency andthose with no immediate risk of developing a dental complication.Resultst5% of the residents were totally dependent and the remainder weresemidependent. Almost a third (31%) experienced at least one episode ofpulmonary infection over the 18 months The frequency of broncho-pulmonaryinfection was not related to the degree of dependence The dentate subjects (49".,)had generally very few teeth left (median X). Almost one third (2'J"o) of theseteeth had caries and more than liair(56%) ofthe subjeets had serious periodontaldisease. Among the edentulous subjects, 71% had no or poorly functioningprostheses. The dentate subjects had twice (1.9) more nsk to have pulmonaryinfection than the edentulous. Half (48%) of all the subjects had oral diseases orfaulty prostheses that eould constitute a latent dental emergeney. In this group therate of pulmonary infection was 1.8 times as high as for the patients withoutemergeney risk factors. Among those who had dental emergency treatment (22°o)the nsk was 2.2. PI was significantly higher (P= 0.04) among the subjects whohad one or more episodes of pulmonary infcetion.ConclusionOral neglect increases the nsk of broncho-pneumonia in very old residents ofnursing homes. Improvement of oral hygiene and dental care should be intro-duced also to lower the rate of pulmonary infection among the frail elderiy.Supported by the Swiss National Researeh foundation.

Q Ethics and aspeets of social welfare m the treatment of elderly patients•=* G. BIAGINI, R. SOLMI, M.G. GANDOLFI, F. ANZIVINO, L.

DALL'OPFIO, A GODINO A, G. GUALANDi {Human Morphology In-stitute. University of Ancona, Italy)

Speaking of the 'Elderly' or "Aged", attention is given to two eonditions that cangenuinely reflect different qualities of life for persons already well into thesecond half of their expected life span. Likew'ise dentally and stomatologicallythe quality and the biological, clinical and functional state of the variouselements making up the oral cavity can ditTer according both to a person'sgeneral state of health and to the greater or lesser degree of conscientiousnessand preeision exercised in loealized care, individuals of middle age included.Indeed even in the ageing process, which is characien/ed first and foremost byless effective and less efFJcieot molecular and cell activity and meiabolie/tormo-nal imbalances, the impact of specific local and geneml diseases both assoeiatedand concomitant can be hea\7. Aecordingly, this study' was conducted partly onthe basis of a questionnaire circulated among elderly individuals (65 and over),and with a twofold object: I) to characterize the main structural aspects and thepnncipal changes discernible in the oral cavity of an elderly subject; 2) to defineminimum acceptable levels of ftinctional efficiency more exactly, with the endin view of securing a suitable quality of life for the elderly, including those af-fected by a variety of problems, not least from a stomatological standpoint.

"On behalf of the Italian Society of Genatric Dentistry.

Alternatives to conventional fixed prosthodontics: Realistje or beyond theXJ. scope

N.H.J. CRBUGERS (Dept. of Oral Function and Prosthetic Dentistry,University of Nijmegen, The Netherlands)

The benefit of denial restorations is mainly determined by function, comfort anddurability. Due to the complex fabrication procedures and expense of conven-tional fixed bridges, this type of dental restoration is supposed to function tor along period in selected patients, such as in elderly patients, the teniis function,comfort and durability may ha\e other meanings and therefore other conse-quences, ln this paper, a number of clinical criteria will be discussed in relationto conventional and adhesive fixed prosihodonties. Also data from longiliinalclinical studies are used to compare lhe elTectiveness ofthe dilTerent restora-tions. The meaning of these cntena and data will be extrapolated for the group ofelderly patients.

Gerodontology

Abstracts: ECG 1995, Amsterdam 113

;iiul p rDs l lu i Jo i i l i c s s l a l c nT pa ln ' i i l s in hiiniL- n i i f s in j ; in

-^ ^ compi i r i son with iiiluihilant.s o\ nM p e o p l e s liiiusc

R MAfK,(i,K.SIl-HI-RT(Dfn(iil-schiiiil FU. Berlin, ficrmany)

Hecaiisc olthe inipniM: merit m iiieJicine ihc uvcnijje life expccliincy LilpedpleIII ilie imluslruil nations in the l;isl century liiiiJ risen. In eusc nf iho necJ olnursinj: hy iilil people miisi be wighl bclween luimc nursing or put into ;i hometur olJ people The aim ol iliis examination is lo Hnd oul ihc dilTerence ut bolhgroup.'; in denial rmilings :inJ prostlioilontics treatnieiit. There were examinedMIS home nursing palients (22.2"u men 77.8"o Icmak'. average ago 81,7) and115 inhabitanis of an old peoples lioii.se (30.5"n men, 6').5"o female, averageage 78). The clinical evaniinatioii rollows the standardii^cd preeondilion ofthestudy oT Ihc WHO. The judgement of Ihe parodonial slate was made by iheCPITN-Index. Al least was put down in writing the kind of prosthodontic ircat-nienl, as well as in a questionnaire the behaviour of mouth hygiene. Tlic resultsshow tor patients in home nursing a palhoiogical paroctontal stale in 97% (80"'oat inhabitants of an old peoples house) The most finding was scale wiih 47.8"o(2l,4"o) and gum pockets with a depth of 4-5 mm in 45.2% (31,0%). 64"o(30,6''o) are toothless, 8S.2"o (24,3°o) had a partial denture in the upper jaw.71.3% (41,7%) had a partial dcnlure in the lower jaw. In comparison to theexamination of practice palients and inhabitants of an old peoples house yousee house nursing patients had a clearly bad slatus quo in the mouth. LANDTguesses that 7()-'iO''o of patienis ate satisfied with the deniure in the upper jawalthough in many euses corrections of ihe dentures must he done The ability ofadaptation by seniores and mhahilants ol an old peoples house is amazinjj highThe oral-hygiene eare and denial support of old peoples should nol be neglectedand should be integrated in the education of geriatne nurses

14 Comparative dental findings and the dental supply ol' senior eili/cns indental practice and in a home for the agedF, MACK. G.K. SIEBERT (Dental School FU. Berlin, Germany)

Because ofdissolutionof family structures many old people live alone. The aimof (his examination is to show the establishing of the status quo and the ehangeof the mouth situation of seniors in a denial praetiee and in a home for the aged.There were examined 11 i patienis (41.4"omen. 58.6"o female, average age 68}of a dental praetiee and 115 inhabitant.s of an old peoples home. The eliniealexamination follows the standardi7ed precondition of the study of the WHO/USPHS. Ihe dental findings follows the DMF-T-lnde\. The judgement of theparodontal stale was made by the CPITN Index. Al least was put down inwnting ihc kind of prosthodonlie treatment, as well as in a questionnaire thebehaviour of mouth hygiene. The results show the praetiee group with a DMF-T Index of 24.28 had better merits Ihan Ihe inhabitants of a home for the agedwith an Index of 25.''6. 80"n of holh groups had pathological parodontal find-ing. The most finding is scale and gumpoekels with a depth of 4-5 mm. Thepraelice group only had 7,2'*'D toothless patients, the group of a home of the age30,4%. Aeeordingly 30,6% of praetiee patients (24,3" D of inhabitants of an oldpeoples home) had in the upper jaw a partial denture and 45,9% (41,7% ofinhabitants of an old peoples home} a partial denture in the lower jaw. Beeauseof the rare visits of inhabitants of an old peoples home to a dentist as seniors athome must be asked that the inhabitants of old peoples home should be morelooked after intensively dentally by the dentist and the nursing stalT.

Tlic role of health practitioners in Ihc prevention and treatment of oral5 disease in aging patients

R.L, ETTINGER (Dept. of Prosthodonties, Dows Institute for DentalResearch, Universitj' of Iowa. USA|

Geriatne assessment varies considerably between sites and programs. If aprogram is interdisciplinary, rarely is a dentist asked to be part of the team. Ajidoral status is rarely included. The questions this raises are: 'is the oral eavity anintegral part of a person and their personality''", "k dentistry an important healthserviee or is it a luxury?'. 'Ismamtainingoral health important to older adults?'.In the past, the majonty of older people were edentulous and rarely used dentalsen ices, tpidemiolngieal studies have shown that the majority of older adultsare now dentate and if now they have a problem they need the services of adentist. The elimination of oral infection becomes important for survival inpatients with eardiac valve disease, with prosthetic devices, immunosuppresscdpatienLs or unstahle insulin Jependenl diabeties. Oral assessment is needed toprevent osteoradionecrosis for radiation therapy of the head and neck. In neu-rological disease such as Parkinson's Disease or dementia, when the diagnosisis made a dental consultation should follow, so that long tenn oral health earecan be planned. Emergency dental treatment becomes extremely difTieult in theseverely cognilively impaired older adult.s. Oral caneer has a higher risk ofoccurring than leukaemia, cancer of the lirain, liver, hone, thyroid gland, stom-ach, ovary and cerv'ix and is easy to treat but only in Ihe early stages. There areguidelines for health professionals to refer a patient for ora! health evaluations;such as, orofacial pain, oral mfeetion. difficulty cleaning Ihe teeth, haliiosis,burning mouth, or a visible lesion Also (ooth related factors such as dentalcaries, loose or mobile teeth or bleeding or sore gums and/or ill-tltting dentures,or obvious signs of home repair. Mosi older persons visit physicians and otherhealth practitioners more often than dentists. TTierefore. to achieve these goals,health practitioners must be taught how lo do an oral examinalion.

-I -3 Treiitment of elderly with ovcrdcnture.s: Clinical and progno.slic a.speetsIi. BUDTZ-JORGKNSKN (Division of Gerodontology and RemovablePro8lhudontics. University of Geneva, Switzerland)

(Ivcrdentures supporleil hy Inoth abutments or by permueosal implants are aprelerahle alternative lo treatment wilh eonvenlional complete dentures. Themam advantages are decreased resorption of the residual ridges, psychologiebenefit for the patient and maintenance of masticatory performance, Treal-ment with overdentures supported by rooLs is particularly indieated for pa-tients with extensive tooth loss and marked loss of periodontal attaehment, aswell as for those in whom treatment with implant-retained prostheses is notfeasible for economic or anatomic reasons. The usefulness of overdentureshas been limited by the susceptibility of the abutment teeth lo earies andprogressive periodontal disease. The development and progression of eanesean lo a large extent be eontrolled even in elderly patients by introducing arecall program and a high level of patient cooperation wilh regard to mainte-nance of oral hygiene. Not weanng ihe dentures at night and/or regular appli-ealion of ehlorhexidine gel is an efficient preventive measure in earies suscep-tible palients. Plaeement of copings also reduces the earies risk. Reducedperiodontal support in combination with overdentures is not neeessarily asso-ciated with a poor prognosis. However, the maintenance ol periodontal healthIS a major problem in overdenlures wearers. The following measures seem tobe important, meticulous oral end denture hygiene; surgical eradication ofexisting periodontal pockets; abstinence from wearing the dentures at night,and/or regular use of ehlorhexidine gel. Placement of copings and attachmentshould nol take place before the patient has shown thai he is able to cooperate.It is likely that in elderly palienls overdentures on implants have a morepredictable prognosis than overdentures supported hy natural roots. However,in the maxilla overdentures on natural roots are particularly indicated becausefour implants with ngid connections are necessary to supporl the prosthesis.Generally, treatment with overdentures supported by natural roots is very cost-efTeetive.

15Negative Air Ion effeet on the viability of Actinomyees naeslundiiisolated trom active pnmar>' root caries lesionsFM BURKE, E. LYNCH', D BEIGHTON-, R. LUDFORD^('Department of Conservative Dentistry, London Hospital Medieal Col-lege;-Oral Microbiology, RCS Department of Dental Sciences, KCMSD,London. UK)

Actinomyees spp. and Aetinomyces naeslundii in particular, represent asignificant proportion of the flora of actively demineralising dentine associ-ated with pnmary root earies. The ability' of negative air ions (NAI) to killActinomyees naeslundii strains isolated from active root canes lesions wasdetermined. The NAI were generated by a system which produces freeradicals which act as a surface microbicide. Strains of Actinomyees naeslundiigenospecies 1 and 2 were plated onto Fastidious Anaerobic Agar (FAA)supplemented with 5̂ 0 horse blood suspended in broth and plaied onto FAAto give a bacterial density of approximately 2x104 ef"u/nun2. The emittertip of the NAI system was held 5 mm from the pbie and a curreni of 60 mAapplied for penods of 30, 60, 90 or 120 seeonds to different areas of theplate. The plates (n=10) were ineubated anaerobieally for 48 houR at 37OC.The diameier of the zones of inhibition of growth were measured using amicrometer. The diameter ranged from 0.25 mm after 30 second NAIexposure up lo for 4.5 mm after 120 second NAI exposure. The negative airion system is an effective agenl at killing Actinorayees naeslundii. The effectwas rapid and time-dependent.

Supported by Dentron Ltd 111.

17Eleciromyographie study on the masseteric silent period m olderdentate subjeets and denture wearersA.E. KOSSIONl, H.C. KARKAZIS (Dental Sehool. University ofAthens, Greeee)

In developed countries the proportion of edentulous elderly persons stillremains high. The loss of teeth and ponodontal receptors and the rehabilitationwith complete dentures severely disrupt the sensory input from thestomatognathic area to the eentral nervous system. The aim of the present studywas to invesiigate any vanations in masselenc reflex activiry in edentuloussubjeets wearing complete dentures, eompared to a deniate group with similarage distribution Tlie silent period was elicited by chin taps in 22 healthy olderdentate subjects wiiii mean age 61.3 years and in 22 experienced denture wearerswith mean age 62.1 years. Eleetrnmyographic recordings werx; obtained fromthe masseier muscle of ihe preferred chewing side al 40";. clenching. A periodof inhihilion (sp) was recorded in all subjects aller all chin laps (100"o). In thedenture wearers the latency of (lie reflex was signifieantly increased {P<0 05),while a tendency towards increased duration values was also observed. Theloss of penodontal receplors and the reliabilitaLion with complete dentures didnot significantly alter the masseteric sileni period. It ean be suggested lliat ihepenodontal receptors are nol solely responsible for ihe silent period aftercliin-taps, and/or their role was taken over by other reeepturs (eg. mucosal,TMJ) as pan of an adaptation process.

Volume 12, No.l

14

All oriil liojiltli usNeNsniL-iil iiirricJ out by luir.scs to identily HULT pcniiL-J- o ncciliii^ udvicc und support in iicccssiiiii; ilcutul sci^vices

J,E, GRIFFITHS (rardilT Dental llospitnl. CnrdifT. Unilcd Kingdom}

lo idcntilv older |H.'f>plc nci-iiinj; iidvu'c ami Mipporl in inccssiny dcntiilscr\'iL'cs bv mciins ot'ii '.impic unil licnlth usNCssmoni The nsscssnicnl recordedreported denial sl;itiis, aj;c ol dL-iiluiVN. pL-rccived onil needs. di.-nl;it .ittciulancebehaviour and rcgistr.ition tor dcntiit care in u sample nl'oldct people altcndmgu Day Hospital lor Can; of the l-Iderly. The assessment wiis carried out bynursing statTon new a'rcrrals(185)ovi.T a period of 4 months, dy/o were eden-tulous and 83°o wore dentures, b'i'o of dentures were more thnn 5 years oldApprosmiately 31 fo reported dental registration and 37".D reported problems,however W o were assessed as nt'cding informatjon, advice, or support in ob-taining dental care. Those noi nxciving regular dental care and if agreeiible,were assisted m contacting a denlisl. .S?"!) were ctintatted. I d"!! Agreed to see aGencnil Dental Pmclitioncr and 34''o were referred to the Community DentalScr\'ice. The study dcmonstrjles the useliilness of oral health assessment ofidentitS' older people w ith onii health nci-ds and ilic potential for advice andsupport in accessing dental scr\iccs. and thereby screening for or^l cancer Itconfinns the role of health professionals in opportunistic identification of thisgroup. The assessment is now canned out routinely on all patients referred toCan: ofthe Elderly in the Day Hospital.

20 A unique community dental geriatric clinicJ MANN, A MERSEL (Hebrew University Hadassah School of DentalMedicme. Jfru.salem)

Gerodontology is taughl at the dental school in Jerusalem both in undergradu-ate and graduate levels. The undergraduate program had minor changes duringthe last 15 years. Efforts have been made through the years to develop a gradu-ate program, efforts which failed on 'political' and personal basis Three yearsago. a unique cxpenencc had been explored. A genatnc dental centre had beenestablished by the Department of Community Dentistry and 'Yad Sara', avoluntary' organization aiming at a5sisting the sick and the geriatnc populationThe facility, wilh 3 dental units was built within a community as an outreachprogram. Dentists employed arc all volunteers, who are compensated not fi-nancially, but by receiving knowledge both clinical and theoretical via a welltrained, well known gerodontologist. Patients are not selected and payment fortreatment is minimal. This facility attracts several trainees, more than needed, afacilit\ which will accept only those dentists motivated to tcrmmating a twoyear program in order to be qualified as fellows in genatnc dentistry. It isimportant to note that one successful facility has changed the faculty's attitudetoward a graduate program in geriatnc dentistry and is a keystone in develop-ing a specialty in geriatnc denlistry.

^ --J Recording individual mandible movements for dentures^ •^ A. RUSPA, A. TRISOGLIO (Centro Culturalc Odon tos toma tologico.

Torino, Italy)

The purpose of the technique here described is to reproduce the mandiblekinematics individually in constructing a prosthesis for an elderly person: itshould be precise without having to oblige the patient to sit for hours. Thepersonal method the Authors want to dcscnbe is the use of three face-bowssubsequently applied. First the nght and the left hinge a.xes ofthe patient are tobe found out. One face-bow (Gysi bow) is apphed to the infenor occlusionblock and so the sagittal movements ofthe condyles are found out: on the samefork attachment of the Gysi bow a second face-bow is then applied: this one isprovided with a comparator for recording the Bennet movements. A third face-bow is joined with two writing pens on the left and the right to transfer the dataon a plate set on the forehead ofthe patient. Thus a scientific and individualcotisTruction of a denture can be obtained, wnth little effort on the part of thepatient. In fact, he can have some relaxation between the trials on, or therecordings can be carried on in a subsequent session The data obtained shouldafterwards be recorded on a completely adjustable articulator. By this methodthe patient can stand the uneasiness ofthe denture better, stand fewer sitting-insfor final alterations after applying the prosthesis, and get better masticatorymovements than by a mean value articulator

'-) yi Oral rehabilitation in Ihe elderly: A comparative study ingero-implantologyJ BALLESTFR.C.H MOULLIN

It IS now commonly admitted that in order to provide to the edentulous elderlypatients an acceptable oral rehabilitation, implanlology is one ofthe best solu-tion. The very small surgical involvement, the simplicity ofthe restoration tech-niques, and the relative low expenses are the indications of this approach inGerodontics. In our study 3 prosthodonlics type of restorations have beenanalyzed. Simple retention systems like bars or ball-attachments, BrSncmarktype bridges, or hybnd prosthetic devices Our research handled, mechanic,functional and aesthetic factors, in order to determine the most adapted .solu-tion for the elderly patient.

-1 Q Whal sort of teeth .scl for a bi-maxi!lary piezographic prosthodonticP KLEIN (SoeietiJde Pruthtise Adjointe Functionnelle, l'ari.s Frunce)

I'le/iigraphie full prosthodiinlie metliud is Ihe best technique In mouldbi-maxiliary prosthesis for gerodontologie cases with flul mandibularsurface.s. With pic/ography, Imri/cinial nverbite.s are funclionul and in 2/3 ofthe cases occlusion's classes are 111 in molar regions and M in buceal ones Aswith these horizontal overbites it is very difficull to set cusped teeth, ;ind aslaborutory cannot modify pie/ygraphies, il is necessary lo use another typeof teelh: then we propose an equilibrated occlusion with flal cusped teelh.This teehnic use butciil acrylic Iceth. Posterior equilibrating mandibutar sec-ond molars built especially lor the case with composite and lateral modifiedceramic units (molar & bicuspids) fruni standard sets. Maxillary set is bigger(form I2or 13 of vita synofomi) than mandibular scl (10 of same type) Alllhe units are waxed up on a semi-adjusluble articulator wilh piezogruphic'skeys in piezographie's trial dentures. This setup as il is perfectly adapted loinstability of gerndnntologic masticalory muscles, gives to the fzerodoniologicpatients the opporlunily to move their mandible m all the positions of thehorizontal envelupe of movements without displacement tif mandibularprosthesis nor trauma of residual bone and mucosal tissues Hyperplasicpathologies are dramatically reduced and common is also dramaticallyimproved. An aquilibrated occlusion with flat cusped teeth cannot be asidebecause it is perfectly adapted to the instable and problematic condiiions ofthe edentulous gerodontologic people

Q -| The rational for fabricating t\̂ 'o sets of complete denturesI GILBOA. V MILLER V, A MERSEL (Hebrew University HadasdahSchool of Dental Medicine, Jerusalem, Israel.)

The provision of complete denture prothesis is a long process, both or thepatient and in terms of technical procedures. In the Glossary of Prosthodon-tic terms (1994) a duplicate denture is defined as. 'a second denture intendedto be a replica of the first'. With improving standards of living and quality oflife, it IS no longer socially acceptable for people to be without their leetheven for the sort time it takes to alter or repair them. The presence of a secondset of personalixed dentures facilitates the maintenance procedures andprovide a psychological comfort to many denture wearers There arc clinicalsituations and mainly in genatnc patients, where it is desirable to provide Uvosets of dentures: e.g. A spare sel m lhe event of accidents such as breakage ormaintenance procedures. An index of positioning for implant dentures. Hav-ing a second pair of dentures with bases similar lo the first will reduce diffi-culties of adaptation. Satisfy the laws uf Kashrut. This technique requires noextra clinical steps and no additional equipment other than found in dentallaboratories. We believe that lhe only problem would be at the basal surfaceas the other denture factors such as oeelusal plane, condylar guidance andanterior anangement of teeth would not be altered to such a great extent w ithage.

Prosthodontic rehabilitation of the edentulous mandible-bar orZ J telescopes on implants

K.A SCHLEGEL, J, WILL, R. MAIERGUNTHER(Dept of Oral and Maxillofacial Surgery, University of Munich)

Refemng to the prosthetic treatment strategies ofthe edentulous lower jaw incombination with enosseous implants one can find vanous opinions in theinternational literature. In the Anglo-American and Scandinavian area the barretention for removable solutions is favoured.On the other hand in central Europe one can find quite a number of reportsabout the treatment of such patients with telescopes or conuses. The treat-ment with double crowns seems to achieve at least the same results at thepenimplant tissue as bar retentions do In addition, especially the elderly pa-tient, with an increasing manual disability, needs a suprastructure design whichhe can easily manage. Knowing that today enosseous implants bave a livingexpectancy of more than ten years the prospective planning of suprastruc turesnot only dental wise but also considering general medicine and genatriefactors should be a main aim in implant planning. Geriatric treatmeni will bea muin lopic in implanlology ofthe coming decades. Therefore, it will be ofmajor interest to gain statistical secured information on clinical treatmentconcepts for these patients. In the presented study, we compare data of bothdesign possibilities retrospectively. Therefore 2(10 implani post supplied withbare retentions and 200 implant posts supplied with telescopes wereclinically and radiologieally evaluated after a mean weanng period of 36months.

The received chmeal data, demonstrate that there is no clinical significantdifference between both gruups. This includes as well the results of thepariimplant tissue as also lhe radiological findings. Nevertheless, in conclu-sion, we believe ihat due to the easier accessibility and the possibility to re-pair the suprastructure in cusc of a single implani Inss using telescopes ratherthan bur retentions is a more suitable prosthodontic rehabilitation concept forthe aging patient.

Gerodontology

Abslracts: ECG 1995, Amsterdam I 15

lontiikigy. The Royal London cxjicricnuu linking; piist-wiih rL"sc;ircli

M.R. HI-ATI I, I'.M. HURKI' (The Koyal Lnrulun I InspilLil, I InivL-rsily olt.or>Jon, I-ngland)

Today's demists need education: today's pulieiits need treutmeni. Few ol lhepresent profession have any fomiiil education in Gcrodonlolojiy, hul many liavemuch wisdom and experience, ilecaiise nl' ilie variuhilily between dilTerentpractitioners, an ediic;ilii.mal priit;raninie needs to complimenl the experience <ileaeh indi\n!ual anil to serve Ins educational drive and votalmnal needs, includ-ing academic specialists, specialisl prattitinners community ilentists withrespttnsihility for special needs and genenil praetitionerswhnhave wish to extendthe range ol patients whom they can serve. There are examples available to ser\'eas models tor design ol' further education. These range from very short coursescovering speeil'ic techniques for general practitioner.s through to full-time PhDresearch. Our e>ipenence at the Royal London Hospital has centred towards aMSc degree course in Gerodontics linking vocational trjining and research forthose w ho want lo stretch their minds. This course includes major components in(ienatnc Medicine and elements relevani lo patients who are frail or mcdiLallycompromised. Obviously, within the Clinical and Vocational training majorcomponents are ineluded on Restorative Dentistry. Research projects, chosen bysiudents the basis of their interests, have covered functional impairment withageing and toolh loss; functional restoration following treatment includingimplants; root eanes and adhesive restorative material; epidemio!og>'; treatmentneeds and appraisal of treatment success.

Oral health status of elderly people in Belarus^ I V. ORDA. H. DOVGALO, M. POPKO, P. LEOUS (Denial Faculty. Minsk

Medical Institute. Republic oi" Belarus)

Most of elderly people in Belarus had benefited from free public or health carelife-time Tbis was the first study undertaken to examine their oral health. Thestudy population compn.scd three age groups: 55-M years (n=485); 65-74 years(n=426l and 75+ (n=481) randomly selected m six administrative regions. Theywere examined under standard conditions to determine dental caries, dental carelevel and treatment needs using the WHO oral health assessment form. Overall27.6% of subjects were edentulous, with edentulism prevalence increasing steadilywith a 3: 10,3%, 27.9%. 44.S",* accordingly. Average DMF teeth was. 71.8 in 55-M age group; 26.8 m 65-74 age group and 30.2 m 75+ age group, of whichpredominant status were missing teeth, increasing from 15,5 (55-64 yrs) to 27,4(elder group). Ration of average filling to decayed teeth was 2.2 I, Average needtor a unit of bridge element per subjeet was 8.2; need for all kinds of removabledenture were 71"u, Oral hygiene and penodontal conditions were poor. Oral healthof elderly people m Belarus was found to be neglected although edentulism preva-lence was on the moderate level.

r~. j - . Dental care in genatnc care units in Germany"̂ y C. PAULI. P- fCRAM. G, SIEBERT (Freie Universitat Berlin. Berlin,

Germany)

Aeeording to a survey by the Federal Labor Ministry tbe current situation inGermany is as follows: one in ten persons over 80 requires special geriatric care.Of the 1,7 million persons requiring geriatric care, 450.000 are in nursing homes.4% are 65 and 20% are older than 'JO. 75''o of those requiring care are cared forat home, primarily by family. The lack of qualified personnel, the setting ol'amaximum eare rate and the question of who is to bear tbe costs are tbe maincauses of patient dissatislaetion. not only in general medicine, but also indentistry. The goal of the study was to determine tbe level of dental preventivecare for those in-patient genatnc eare. A standardized WHO questionnaire andexamination by a denlist were utilized in the study, 364 Patients, average age84,9 years old, from different genatric care in West Berlin were involved in tbestudy. Woman represented 87.3°o The average length of the stay in the geriatnccare units was 32 months. Oftbose in care 62.7% bad the possibility of visiting adentist with the help of a handicapped bus However only 34.1 "-n had actuallyvisited a dentist in the lasi tlve years. Of those surveyed. 75,1% bad a completemaxilla and 58,4''i a mandible prostbesis. Only 45.3"o of those examined by adeniist bad a satislaetory prosthesis hygiene. Changes in tbe mucous membraneof the mouth induced by prostheses were determined in 28,6%. Dental treatmentof prostbeses was necessary for 80.ro, however 63"o rejected the treaimeni. Apossibility for improving rehabiliintion measures would be the patients regain-ing a feeling of independenee. what presupposes a personal and ciist-intensive'holistic care'.

Prc-fabnciited Dentures3 2 o RUDBERG, A MERSEL (Dept of Community Dentistr>, Hebrew

University Hadassah School of Dental Medicine, Jenisalem, Israel)

A large part of the older population needs full dentures. Tlie preparation processis usually long and consumes up ti) 4-10 sessions. In certain eases there is a needfor immediate handling. For example: dentures following serial extractions,temporary dentures as part of rehabilitation processes such as implant surgery,denlures for the compromised geriatric patient etc. To answer such demands animproved method for preparing full dentures, in one session, was developed.Pre-fabricated sets are processed in the clinic to become full dentures thai sUindup to many of the criteria relevant lo sucb treatment.s.

linplarii Ocnlistry m the elderly risk or benefjl2 6 ' NAIKTI.M HOO(illEI,D VAN .STF,ENBRRGHEN^ ('DepartmenI

of Prosthetic Dentistry, 'Department of Periodrjntology, University ofLeuven, Belgium}

Althougli the heating process is slowed in old individuals, resulLs from the clinicalmvestigation.s have documenled Ihal the aged palienLs generally heal well. Kondelfl III. invesligated the inlluence of age on osseointegraled implants comparingthe outcome of treatment in a group of yuung and a group of elderly patienls.The overall success rate was similar in both age groups Thus the alteredbinliigieal responses and tbe decreased bealing eapaeity in tbe aged is of minorclinical significance as long as the optimal conditions for wound repair ean beachieved, which means that surgery should be performed as gently as possible.More important to judge, if a patient is a candidate for oral surgery, is thegeneral bealtb status of the patient and the altered tissue responses and healingdue to systemic diseases which increases with ageing. If age does not biologi-cally influence the treatment outcome one may wonder with bow manyimplants the patient is best served taking in mind the dual eoneept ofcost/ benefitand nsk/tenefit. ln the elderly age group many have lost all tbeir teeth due tocaries, penodontal disease or iatrogenic factors. Patients may benefit a lot ofimplant-retained treatment modalities These are framed between the remov-able overdenture retained by two implants and the fixed full prosthesis retainedby five to six implants. Tbe decision between tbe above mentioned treatmentmodalities is mainly determmed by finance. Other benefits of the overdenturetreatment are: ease of maintenance, complele restored arch and ease to reach acosmetic acceptable result. The results of an up to 9-years retrospective studywitb mandibutar bar-retained overdentures on two Branemark implants, indi-cating a cumulative small failure rate (3%) and a physiological stable boneapposition (0.05mm''y bone loss) around the implants, will be discussed.Implant dentistry is of great benefit for the elderly patient

O Q Prosthetic and oral mucosa m the elderly, parafunetionC. BRU DE SALA. R CABALLERO (Um versidad de Barcelona. Facultadde Odontoiogia. Spain)

L«sions of tbe oral mucosa, most commonly found amongst tbe elderly, areso-called induced lesions or lesions related to the use of removable prosthetics.The etiology of lesions of the oral mueosa has not been dealt witb in depth anddifferent, contrasting theones bave been put forward. In this work we havetried to clarify the etiology' of the lesions hence enabling us to prevent and dulytreat tbem. We believe that removable prosthetics retransmit tbe pressure of thepara functional movements made by tbe patient to the mueosa the supports themIn other words, prosthetics play a mediating role in these lesions and they arenot the causal agents. As a result of this paraftinctional pressure not onlylesions in the mucosa anse but also anatomical changes in tbe alveolar boneoccur. This work also proposes a way to classify tbese mueosa lesions.

-̂ ^ Fitting dental dietary advice into tbe roles of food for elderly mentally-^ ^ ill people

J. FISKE. W.H. ZHANG (King's College London, United Kingdom)

Tbe study aims to identify the roles of food in a day-centre for elderly mentallyill people, so that dietary recommendations for optimal dental health are madewithin the overall philosophies of daycentre care. A qualitative approach wasadopted. It compnsed an observational study of tbe daily routine, and a semi*structured interview to examine atiiiudes. beliefs and knowledge of tbe carestaff related to diet, bealtb and dental bealth. The use of food was centra! to thefunctioning of the centre. Food wa,s used for nutntion, as a focus for commu-nal activities, to express love and caring, and to maintain cognitive, daily-li\ -ing and social skills. Sugar was generally regarded as detnmental to bealtb. bulattitudes towards use of sweeteners as an alternative were mixed. All statTconsidered dental healtb important, and appreciated the link between teetb,bealtb and diet. One-tbird of carers considered tooth loss an ine\ntable conse-quence of aging. Generally stafi'felt elderly people can adapt to dietary andchanges. Dietary advice for dental healtli would be acceptable if put in thecontext of general health and the changes take account of the overall philoso-pbies of the centre. To this end a 'Healthy Eating Resource Pack' wasproduced. It is being evaluated currently.

31Endodontics in old root canalsW.L. WILLEMSEN (Dept. of Cariology and Endodonlology, Universityof Nijmegen, Tlie Netherlands)

An ageing tooth may present itself wilh speeific protilems when endodontietreatment has lo be perlbniieJ. Extensive obliieration.s, for instance due to theformation of irritation dentine, may make it very dilTieult to test sensibility.Secondly, when root canal treatment is indicated, these obliterations mayhamper the locating, penetrating cleaning and shaping of the root canal system.Funhennore, a fonnerly endoiiontieally Ireatcd tooth may need to be retreateddue lo seeondary, infection, necessitating the sometitnes difficult removal ofroot canal filling matenais. possibly including root canal posts, A selection ofreasons that may render the field of cndodonlies even more challenging. In thispresentation these issues will be highlighted. Their ongm as well as ways toovercome the problems and treat the teeth will be addressed. This cannot bedone without referring to the kmg-lenn prognosis of the vanous trcatmenLs andtreatment modalities. As such, the presentation may lum endodontics into aneven more rewarding experience.

Volume 12, No,

^ ^ tilngivul I'lbrnbliisls in viim. Ajjc-rcliKctl response^ J R SHI Mi, (• TU-T7, C ZUCriMNI. O. TAI ASSI. (I UlAtilNI, l .

CASTAtDINI (Histology InstiUilc. Univeniily orHuli>nrui. lluly)Tlic Ml viin- sliuly was iiiiiicJ iit cluiriiclcri/iiiy plK'niilypiL'iil expressions ofgingival fibrobliisls otiiaiiicil with fiiopsy cvpliinis Inkon from young iinil CIIIL-I lyindi\ iiiuals. CIIIKT hailUiy or iilicctcil liy pcniuliiiitilis. ID the end of discoveringany ciipiicHiCN lor rcaclum iind rvpmr IIKII miglil usefully he taken inlo aeeouniduruig ciiniciil ohser\iition und therapy, (.'ell prolill-ration was studied by evalu-ating the cell multiplication tiielor, ncutnil endopcptidase (ti.C. 3.4.24.11) activ-ity, using colorimelry. also cell area and adlieM\e fibroblast plaque usinginimunolluoresconcc lediniques and image analysis We were atile to show thattheivare nosigmlleant dillercnces in prolMerjtuin poiential and iiciilnil endopepti-dasc activity in fibntblasts nhtainod from young and elderly individuals. Therewere, on the other hand, signilleantly reduced areas of I'oeal adhesion andincreased cell area in tlbroblasts obtained from healthy and disea.sed elderlyindividuals. In contrast to cutaneous I'lbroblusts. those of the oral cavity werecharactenzed by a capacity for prcilitcration and hy levels of en7\'matic activityoccurring at all ages, atmbutable probably to their particular micruenvironment,which IS moistened continuously by the saliva and inlluenced hy growth factors,one which being epidermal growth factor.

"DC How to communicate with elderly patients A dentist's guide• - " S TASSAROTTI, B TASSAROTTI (City LInivcrsity Business School,

London, l-lngland)

In the relationship between the elderly patient and dentist it is essential to createrappon and good communication. Rappon means that the dentist is able todemonstrate empathy with Itie patienfs needs and probiems. Trust and under-standing are the basis of a tong lasting relationship In order to achieve goodcommunication, the dentist needs to be aware of ihc imporiance of both verbaland non-verbal communication While the former is mainly the language usedby the patient, the latter includes how the patienl tiehaves and uses his/her bodyto support the xerbal communication. Tlie role and the responsibility ofthe dentistlays on the opportumrv gncn to ever>'body, to enhance our level of awarenessof how we communicate. This can be achieved through several traininge.vercises in which the dentist ean become more aware of how we communicatethrough the five senses, how our verbal language rellecLs the way we perceivethe outside world, and how 9}''o of our communication is non-verbal. Recentstudies on this subject have demonstrated that it is possible to develop a betterway to communicate with ourselves and others. This opens the opportunity ofimproMng the delicate relationship betiAcen the elderly patient and the dentistthrough the use of these techniques, taken from Neuro Linguistic Programming.a modem branch of Cognitive Psychology. Some clinical examples will be pre-sented to the audience.

Nutntional and oral health status in nonagenanans living in nursing home3 8 A BALDINl, A MARCHESI". D CALVANl" (Inst. of Gerontology and

Genatrics. University of Florence and 'Dept. of Stomatology / "Dept. ofGeriatrics. LSU n4, Prato, Italy)

The oldest old are a cohort of population thai will be more and more important.Biologic markers of longevity raises an important rule to understand ageingbiolog>'. Nutntional inde.x assume a relevant interest, in this sense. Health dentalstatus represent a condition that can be correlated with the main nutritional index;teeth's presence or absence or incongruous denture can be a nsk factor of malnu-tntion. This study is a part of a longitudinal sur\ey on nonagenarians living incommunity and in nursing home in Local Sanitai>' LInit n.4, Prato (Toseana, Italy);in this study is referred about subjects living in nursing home: they were assessedusing a multidimensional questionnaire: nutritional status was evaluated byantropometnc measures and laboratory variables; data on oral health status werecollected on DMFT (Decayed missed filled teeth), periodontal status was evalu-ated by measuring gingival pocketing and loss of attachment. Edentulouspatients were asked about operating of eventual denture with a -ipecial question-naire; subjects without denture were asked about eventual changing dietary hab-its. The 66 subjects lining in Nursing home (5'? female. 7 male, age mean 92.8+2.6)has shown a satisfactor>' nutntional status. Odontoiatric evaluation emphasised aprevalent condition of endentulism; most subjects wear a denture: Subjects with-out dentures did not report a changing of diet; odentoiatric examination surveyeda good dental-parodontal condition, in rare cases in which teeth were present.These simple descnptive data show like adaptative strategies are present in old-est-old: not-correct edentulism, tbat would can represent a predictive vanable ofmalnutntion, really does not correlate with this status.

AC] A kinematic analysis of mandibular function in the edentulous elderlyJ. BALLBSTER.C.H.MOULLIN

The aim of this study is a comparative analysis of the kinematic movements ofthe mandible between edentulous elderly patients, rehabilitated by a implant-supported overdentures The results of this research pointed out a significantdifference between these two groups of patients. Patients who received animplant supported ovcrdenture present, functional achievements very similar tothe dentated patients. This fmding reinforces the fact that gero-implantology isthe best choice treatment for the edentulous lower jaw. and might achieve thebest functional and psychological condition.

^ Ciiniplete denture eompliiints, "prosthetic condition' and oral stcreognosis:An inquiry iiitii correlationsA.A.M, VAN AKHN (University of Nijmcgen. Nijmcgen, The Netherlands)

Successful denture wearing seems to depend, among others, on denture i|u:ilityand patient's denture adaptation. Often a discrepancy exisis between t)ieprolessioniilly assessed guiility and the patient's subjective judgement ol thedenture. t)ne of the causes of this phenomenon may he that the professionali)uulity assessment does not consider the quality of the denture bearingsurfaces (the residual alveolar ridges). Continuing complaints about techni-cally optimal dentures suggest that the adaptation process has failed. Adapta-tion til dentures needs two: the patient has to tolerate the idle denture and tomanipulate the denture during functions as mastieation This requires a good'oral stereognosis'. This survey is an inquiry into possible correlations hetwcendenture complaints, denture and denture bearing surface quality ('prostheticcondition') and oral stereognosis. Tbe .147 participants of this survey werecomplete maxillary and mandibular denture wearers, aged 35-75 years. Theirdentures and residual alveolar ndges were elinically examined hy 10 dentists.Denture complaints were registered in interviews and an oral stereognosis testwas assessed. In the analysis, only professional quality cntena were used withsutllcient interobservers-agreemcnt. The 'prosthetic condition' was assessedby combining the scores for denture and residual alveolar ridge quality. Usingthe contingency coetTicicnt (Pearson chi-square), only a relevant and signifi-cant but nol substantial correlation was found between combinations ofvanablcs ofthe patient's denture complaints and the 'prosthetic condition'.There was no correlation (Spearman correlation cnelTicicnt) between denturecomplaints and oral stereognostic capability

5 Clinical decision making for the elderly patientA. MERSEL, J. MANN (Dept. Community Dentistry, Hebrew UniversityHadassah School of Dental Medicine, Jerusalem, Israel)

As a demographic fact tbe Israeli elderly population is increasing, giving to thedentist exceptional opportunities for additional dental practice growth as wellas the need for special management, treatment planing and dental careapproaches. The aim of this presentation is to focus how to assess and deal withthe complicated and multiple problems commonly seen in tbe genatric dentalpatient. Oral examination strategies will especially emphasize which thoroughlyrecord both Objective clinical signs and Subjective patient perceptions as wellas other very important prognostic factors influencing potential treatmentapproaches. Finally several case history formats will be exposed in order todiscuss appropriate treatment planing decisions, weighing benefits vs costs andrisks, in a way to obtain optimum oral health for the elderly in the future.Intraoral pain and unpleasant Ieeling cause by Candida

Y. MURAMATSU, A. SUZUKI,T. K IKUTANI. K. ISHIDA. K. YAMANF./ S. INABA (The Nippon Dental University School of Dentistry at Tokyo.

Department of Geriatne Dentistry, Tokyo. Japan)

Poorly fitting denture, canes, pulpitis, and periodontal disease are well knownto be main causes of pain managed in dental practice. However, patients some-times complam of pain and/or unpleasant feeling in the tongue or oral mucosa.although they are determmed to have no abnormalities at dental and prostheticexamination and maintain good health It is extremely difficult to identity theexact cause of pain in these patients, if they have only subjective symptoms,without such objective symptoms as ruber and swelling. Sucb pain andunpleasant feeling, may be cause by Candida, in tbe present study, weexamined patients with main complainLs of intraoral pain and unpleasant feel-ing. Though to be cause by Candidia, among 173 patients (mean age 75.3:from 65 to 91 years old) visiting our clinic for tbe first time berwcen March toJune I'594. There were 13 patients (7 5"o) visiting our clinic with a maincomplaint of pain in oral mucosa, and their pains were determined to be causeby Candida in 9 patients (5.2"o) In these 9 patients, 7(4.0°o) had objectivesymptoms, but 2( 1 .l°o) did not. Tbeir subjective symptoms the main complaint,were improved by treatment with an aniifungal agent. Every patienfs com-plainLs should not be simply considered as unidentified symptoms, and shouldbe thoroughly examined in vanous aspects. Candida can be an lmponant causeof intraoral pain and unpleasant feeling. We should keep in mind that elimina-tion of intraoral pain is closely liked with the improvement of the quality oflife.

3 Q Oral health status of an elderly institutionalised populationA.N. OZDEN, B. YURDUKORU(University of Dentistry. Dept. of Prostliodonties, Ankara. Turkiye)

The aim of this study is to evaluate the oral health status in a group of peopleliving in an institution and investigate morphological variables due to the indi-vidual ditTerenccs. All participants were interviewed and clinical examinationswere carried out. When changes of soft tissues were observed the microbio-logical examinations were also assessed. Among hundred and twenty t"iveelderly institutionalised people (sixty five males and sixt\' females) the meanage was seventy six year^. The oral health status was generally poor and S5.S"oofthe population were edentulous. 64.6"n Of all the group were using totaldenture. 12.6" o were using removable partial dentures and only l.h"o had fixedprosthesis. Oral health care programmes may enable elderly institutionalisedpeople to provide hygiene support and receive the dental treatments that theyneed.

Gerodontology

Abst ryc is ; E C G 1995, A m s t e r d a m 117

Edeiituiousness in elderly Germans4 1 I N1TSC1IKF,W. MOPrT-NMULI.FR( Dept. of Dental Prosthetics and Oml

Gerontology. 7.entrum filr 7ahnmedi/in, Chiiritc. Iliimbuldt-l Iniversililt /uBerlin; 'Institute for Medical Statistics, Universitatsklinikiim Hcn|aminiKranklin. Freie Univerxitflt Berlin, Germany)

In the general opinion a very old person is synonymous with an edentuluiisperson. The Rerlin Aging Study (BASE) tries to show that high age does nutneeessarily mean being edentulous. BASE investigates an age-by-sex stratifiedsample of elderly persons (70-105 years) representative ofthe Western districtsof Berlin. The sample was drawn from the City Registry, iind includes bothcommunity-dwelling and institutionalized elderly. Men and the very-old areoverTeprescnted in the sludy About 50"" ofthe interviewed elderly subjectscompleted a 2-hour niultidisciplinary. initial interview, 35"o (N^?16) addition-ally participated in a 14-session intensive protocol involving researchers fromintemal medicine, dentistry, geriatric ciiedicine, psychiatry, psychology, sociol-ogy and economies. Dental interview and dental findings were recorded eitherin the dental clinie. or when necessary, at the subject's place of residence (e.g.apartment, senior citizens or the hospital). In the six age-groups edcntulousnessincreases from 32.5'*o (70-74 years) to 76.3"o (90-04 years), although the high-est age-group (95 years and older 64.5''o) does not show the greatest part ofedentulous study subjects, but the previous age-group (W -94 years) In the groupof study subjects with remaining teeth the medium amount of teeth decreaseswithin tbeditlerent age-groups(70-74 years, denlate subjects: 12 teeth), wherebythe study subjects of the highest age-group on an average have more teeth (7teeth) ihan the previous age-group (3 teeth). The topographical distribution ofthe teeth corresponds with the data of other studies. Analysis ofthe dental statusin high age will enable to measure the success of oral prophylaxis nol only inl2-years-olds, but throughout the whole span of life.

Developing a video-based teaching aid on assessment of tbe elderly4 3 edentulous patient

A.L. FAIRCLOUGH, D.J. LAMB (University of Sheffield, UK)

With the present constraints on personnel and time resources it was felt ncces-sarj' to develop a more efficient method lo teach undergraduate clinical tech-niques. Video was considered the optimal medium tor demonstrating thecommunication skills and diagnostic expertise needed to assess elderly patientsrequinng complete dentures. Students may use the video for reference at home,or in the Dental School for pnvate study, or as a basis for group discussion. Thework involved in developing this teaching aid and the problems encountered arediscussed in this study. Patients were selected for the study who had histories ofpersistent problems with denture wearing or bad dilTiculties with interpersonalcommunication as a result of ageing. Filming took place over ten clinicalsessions, which after editing produced an hour long video suitable for studentteaching. Planning the project prior to filming • script wnting, patient selectionand applying for funding was very costly in resources. Filming patients wasparticularly difficult and time consuming, as was tr>'ing to create as 'near tonormal'a clinical environment as possible. Much editing was required. The cost-effective benefits of this teaching aid are long-term. The video is a valuablereference tool for studeni use, they gain experience of the management ofelderly patients and the problems involved without the need for extra elinicaltime and supervising personnel.

45 Absence of function in totally edentulous patientsC. TADDEl, E. WALTMANN

The absence of ftinction m the totally edentulous patients is a frequent observa-tion. Such situations are observed on patients who do not wear dentures likeelderly persons as well as people who only wear unimaxiilary dentures.Functions like tasting, phonation, aesthetics may be more or less atTected,incision and mastication are in these cases meflicient. When the occlusion islacking, histology obser\ations and hi.sto-morphology studies showed theoccurrence of significant damages on the edentulous ndgc as well as in thetemporomandibular joints.

^-^ Absence of function in total y edentulous patients^ ' S. MONTAL, D. VEYERT (Teaching and Research Unit of Odontology,

Montpellier University, France)

The goal of this study is to evaluate the consequences of using soft lining mate-rials in removable complete denture on the supporting tissues. A finite elementmethod was used to understand the mechanical behaviour of soft matenals andto analyze stress distnbution. The two dimensional models were cumposed of anartificial tooth, a rigid base, a soft base (Performsuft, Lutemoll, Plastulene)mucosa. cortical and cancellous bone. We studied three types of cilcntuious ridges:atrophic, well developed, and fiat ridges in relaiion witb a masticatory load. In alltested samples, soft lining materials, and mucosa became deformed andcompressed. The most important stresses were observed on the residual crestsexcept on the well-developed ridge. So. after looking at the results we chose totest a new distnbution of soft material on the complete denture impressionsurface. The new form makes a scheme like a well developed rid[;e. It increasesthe protection ofthe atrophic edentulous ridge. Our conclusion is that soft liningmaterials are an additional shock-absorber. By placing soft lining materialsdifferently on the complete denture impression surface we could achieve betterprotection of the residual ridge.

ivy Tiitiil quality nssessnicnl in gerodnntiilogyS, NISI/AKI (Complete I'riisthndiintics Dept.. Montevideo, Uruguay)

"I he purpose iif this preseiitatinn is to stinw bricfiy which are the points related111 (Quality Assessment in Ihe area (if gcrodiintnliigy T(t reach the concept ofexLelk-ncf in Ihe treatment ol aged people we have t<i understand that i\ deepknowledge of dentistry is nol enough. Therefore, we niu.st know tlie biologicalaspects of mouth ageing. h<iw health status is in general, his or her psychologi-cal profile and the social environment, lo make easier the understanding ofthis lecture. I will start form the generalized acceptance ofthe three levels ofQuality Assessment in dentistry: structure, process and results. I. Structure:Conceming facilities: It is better to have the dental office on the ground floorEntrance for wheelchairs must be provided. The floor should not be slippery toprevent aged people from falling down. Chairs in the waiting room should behigher than normal ones, heavy and with arm supporters. In this way patientswould seat easily. 2. Process: Within a human, warm and polite atmosphere,assistance of third and fourth age has to be done. Dentists and their auxiliariesshould know their psycho-social condition and according to the situation isthat they have to act. However, treatment planning and treatment itself shouldbe performed with a deep knowledge of the present, near and far future ofageing. For instance, when we decide retention for overdentures it is better tochoose magnets, t>ecause insertion and remotion of dentures is easier than withmale and female system. Magnets provide easier hygiene for abutments anddentures, and increase teeth expectancy in the mouth because abutments arenot so loaded Piezography technique should be applied in all removable pros-thodontics to increase retention, stability and self hygiene. Consequently, weare succeeding in our treatment and gaming comfort. Preventive programs andmaintenance will also be necessary. 3. Results' Quality assessment can be madeby the dentisis themselves, evaluators and the patients itself, answenngspecific questions. A follow-up program will be tbe answer for our t>ehavioursin the future. Better quality of life for our aged people is the objective.

AA Dental health status in old age and nutritional parametersM JIMF.NEZ SANZ. R- VERDUGA, C. FERNANDEZ-VIADERO(Nutritional Unit, Hospital Universitario 'Marques dc Valdecilla',Santander. Cantabria, Spain)

Nutntional factors have been shown to contribute substantially to the aethiologyof many diseases that occur in the later life. With advancing age the risk ofdeveloping serious nutritional deficiencies also increases. Dental problems havebeen assumed to affect dietary intake and nutrition state in older persons, butdiverse studies have been shown contradictory results. We studied the oral healthand Its relation with morphonietric and biochemical-haematologic parameters.An observational andnon-nindomiztrd study was pertbrmcdon 114 elders with-out functional limitations. We have evaluated tbe dental status by commondental index, edentulism prevalenee, caries and filling caries. Tbe nutritionalstatus was evaluated by body weight, body mass index, total proteins, albumin,and total number of lymphocytes per mmV The results obtained are summa-rized as follows:

weight BMI protein aihumin lymphocyteskg }r/dl gr/dl mm'

cdcntulow: 63+13 38±4 7±0.5 3.79±0.3 2O8I±671

/r The effectiveness of instruction for the aged population in dental behaviourS.S. ZIMMERMANN, A. MERSEL (Hadassah School of Dental Medicine.Jerusalem. Israel)

The aim of this research is to check the efTcetiveness of instruction for tbe agedpopulation in dental behaviour and oral hygiene in two projects. The first projectwas mitiated by Eshel-'the HIL" project (Esbel- the association for the planninganddevelopment of service for tbe aged in Israel) The purpose ofthe project isto improve thequality of life ofthe old population by increasmg the awarenessin different fields including dental behaviour and oral hygiene. In this projectcompetitive aged volunteers were chosen to instruct after proper preparationthe aged people to increase the awareness upon dental behaviour. They arcsupposed to do it by frontal lectures and demonstrations. The knowledge isachieved by one lecture and one demonstration meeting on the dental behav-iour all by rubncs that Eshel presented. The lecture was prepared according tothe requirements of Eshel. deciding to use the video movie presented on theECCJ5 in 1994 in Israel - under the name of "the Candidate', produced by MrsY. Ben Moshe. Eshel; Prof A. Mersel. Prof J. Mann and all. Hebrew Universitv'Hadassah School of Dental Medicine. Eor the demonstration purpose we usedthe kit assembled by Prof A. Mersel and useJ in the Genatric Dental Center of"I'ad Sarah Jerus;ilem. The video and the kit remained in the possession ofthevolunteers for reinforcement during the activity. In the second project the firstmeeting was wilh a large group in their club followed by a second meeting inthe dental office ofthe same aged people or mstnictions in small groups. We arcchecking the eflcctiveness of shon lecture combined with frontal demonstra-tion in large groups together with reinforcing meeting ofthe same aged in smallgroups. Dunng tlie small group meeting the aged will fill questionnaires, actiieveoral hygiene instruction using the same kit, watch the same video movie andclinical checking. After a while and from time to time the awareness of bothgroups will be checked. We have to point out that the aged volunteers in thefirst project were ehosen from the second group and similar groups in otherclubs. The purpose of tliis two projects was to check the effectiveness of m-stniction in oral hygiene and dental behaviour and at the end to proposeway to reach aged population for better dental behaviour and oral hygiene.

Volume 12, No.l