Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-20T13:48:46Z No. of bitstreams: 2 Dissertação - Lorrany Cândido da Silva - 2017.pdf: 1733793 bytes, checksum: f8ab882fc9e50895326cd60c7ed5c27d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-20T13:49:13Z (GMT) No. of bitstreams: 2 Dissertação - Lorrany Cândido da Silva - 2017.pdf: 1733793 bytes, checksum: f8ab882fc9e50895326cd60c7ed5c27d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-20T13:49:13Z (GMT). No. of bitstreams: 2 Dissertação - Lorrany Cândido da Silva - 2017.pdf: 1733793 bytes, checksum: f8ab882fc9e50895326cd60c7ed5c27d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-20 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Objective: To test the validity and reliability of a method to measure the masticatory performance of complete denture wearers employing a two-colour gum mixing ability test through visual and opto-electronical analysis. Material and Methods: A sample of 75 subjects was selected from patients who received new conventional tissue-supported complete dentures in a clinic at the Federal University of Goiás. Masticatory tests were performed using a two-colour chewing gum that was masticated for 5, 10, 20, 30 and 50 chewing cycles, performed in a random order. The mixing level of the two colours of the chewed gum was assessed visually by two independent raters based on a 5-point ordinal scale. Then, the specimens were flattened into a 1 mm width wafer, scanned and saved as a two-sided digital image. Each pair of images was submitted to a colourimetric analysis using a custom-made software (ViewGum©, Dhal Software, Greece). The circular variance of hue (VOH) was used as a measure of the level of the colour mixture. The lower is the VOH, the greater is the mixture and, consequently, the masticatory performance. In the current study design, a varying number of chewing cycles simulated different levels of masticatory performance in one subject. The intra and inter-examiner agreement for the visual analysis was measured by the intraclass correlation coefficient and the weighted Kappa. The reliability of VOH analysis was assessed using the Bland-Altman plots. Results: Overall inter and intra-rater agreement in visual analysis was 64% and 68%, respectively (almost 99% of scores ranged within ±1 point). Overall weighted kappa was >0.80 and intraclass correlation coefficient was 0.91. A proportional increase in the level of mixture occurred with increased number of chewing cycles for both the visual and colourimetric analysis (p<0.001). Similarly, VOH and the visual 12 analysis were highly correlated (r= -0.89; p<0.001). Bland-Altman plots revealed excellent agreement and extremely low systematic error between duplicated VOH measures. Conclusion: The two-colour chewing gum test is a valid and reliable method for assessment of the masticatory performance in complete denture wearers using both the visual and electronic colourimetric analysis. / Resumo: Objetivo: Testar a validade e a confiabilidade de um método para mensurar a performance mastigatória de usuários de próteses totais convencionais, empregando um teste de habilidade de mistura de goma de mascar de duas cores por meio de análise visual e opto-eletrônica. Material e Métodos: Uma amostra de 75 participantes foi selecionada entre os pacientes que receberam próteses totais convencionais em uma clínica da Universidade Federal de Goiás. Os testes mastigatórios foram realizados, em ordem aleatória, usando uma goma de mascar de duas cores que foi mastigada por 5, 10, 20, 30 e 50 ciclos mastigatórios. O nível de mistura das duas cores da goma mastigada foi avaliada visualmente por dois avaliadores independentes, com base em uma escala ordinal de 5 categorias. Em seguida, os espécimes foram achatados em uma lâmina de 1 mm de espessura, escaneados em ambos os lados e salvos como imagem digital. Cada par de imagens foi submetida à uma análise colorimétrica usando um software customizado (ViewGum©, Dhal Software, Greece). A variância circular da matiz (VCM) foi usada como a medida do nível de mistura das cores. Quanto menor foi o VCM, maior foi a mistura e, consequentemente, melhor a performance mastigatória. No desenho deste estudo, um número variável de ciclos mastigatórios simulou diferentes níveis de performance mastigatória em um indivíduo. A concordância intra e inter-examinador para a análise visual foi mensurada por meio do coeficiente de correlação intraclasse e do Kappa ponderado. A confiabilidade da análise VCM foi avaliada por meio do gráfico Bland- Altman. Resultados: A concordância geral inter e intra-examinador na análise visual foi 64% e 68%, respectivamente (quase 99% dos escores variaram dentro de ±1). O Kappa ponderado geral foi >0,80 e o coeficiente de correlação intraclasse foi de 0,91. Um aumento proporcional do nível de mistura ocorreu com o aumento do número de ciclos mastigatórios, tanto pela análise visual quanto pela análise colorimétrica (p<0,001). Da mesma forma, os valores de VCM e a análise visual foram altamente correlacionados (r= -0.89; p<0,001). O gráfico Bland-Altman revelou concordância excelente e erro sistemático extremamente baixo entre as mensurações VCM duplicadas. Conclusão: O teste com a goma de mascar de duas cores é um método válido e confiável para avaliação da performance mastigatória em usuários de próteses totais convencionais usando tanto a análise visual quanto a análise colorimétrica.

Abstract Oral health among older people is shown to be worse compared to younger people. The aim of this study was to evaluate oral health and associating factors among ageing Finns. A cross-sectional, descriptive epidemiologic survey was performed in Kirkkonummi in southern Finland and in the Lakeus District in northern Finland. Altogether 1,191 subjects aged 60 to 78 years, 625 from Kirkkonummi and 566 from Lakeus, were examined and interviewed. Edentulousness and poor occlusal stability were recorded clinically. Gonial angle, ramus height, condylar height and the amount of residual ridge resorption in the mandible and the presence of fixed prostheses were evaluated from panoramic radiographs. Based on the radiographs the scoring of infection foci was performed with an infection focus index. The signs of infection recorded were deep caries, periapical lesions, furcal lesions, vertical bone pockets and horizontal bone loss. The prevalence of edentulousness was 37%, being significantly higher among women than among men and significantly higher in the northern compared to the southern region. Edentulousness was more prevalent among subjects with primary school education than among those with higher education. The mean of the gonial angle was smaller among dentate subjects than among edentulous ones. Dentate subjects had significantly greater ramus height and condylar height than edentulous subjects. Women had significantly more often than men severe residual ridge resorption in the mandible. Poor satisfaction with dentures associated significantly with poor occlusal stability in both genders. More than three quarters of the subjects had severe risk of infection, more in the southern than in the northern region. In the dentate sample women showed higher prevalence of fixed prostheses than men. In the Kirkkonummi region both men and women had more fixed prostheses than subjects in the Lakeus region. Edentulousness was very frequent among ageing Finns. Mandibular bone morphology changed as a consequence of tooth loss. The prevalence of fixed prostheses was low and the prevalence of signs of infection of dental origin was high. The geographical differences in oral health should be considered by health authorities in order to promote good oral health in rural areas, especially focusing on older people with low socio-economical status and poor health. / Tiivistelmä Vanhusväestön suun terveydentila on useassa tutkimuksessa todettu huonommaksi kuin nuoremmilla. Tämän tutkimuksen tarkoituksena oli selvittää suomalaisen ikääntyvän väestön suun terveydentilaa ja siihen liittyviä tekijöitä. Epidemiologinen poikkileikkaustutkimus tehtiin Kirkkonummella Etelä-Suomessa ja Lakeuden terveyskeskuksen alueella Pohjois-Suomessa. Tutkimukseen ja haastatteluun osallistui yhteensä 1191 iältään 60–78-vuotiasta henkilöä, 625 Kirkkonummelta ja 566 Lakeudelta. Kliinisessä tutkimuksessa selvitettiin hampaattomuus ja proteesien purentatasapaino. Alaleuan leukakulma, nousevan haaran ja nivellisäkkeen korkeus, hammasharjanteen korkeus ja kiinteiden proteesien esiintyminen arvioitiin panoraamaröntgenkuvista. Tulehdusriskiä kuvaava indeksi arvioitiin röntgenkuvien tulehdusmuutoksista, joina rekisteröitiin syvä karies, hampaan juurenpään tulehdus, tulehdus takahampaiden juurten haarautumassa, syventyneet luutaskut ja kiinnityskudoskato usean hampaan alueella. Hampaattomuuden vallitsevuus oli 37 %. Se oli tilastollisesti merkitsevästi korkeampi naisilla kuin miehillä ja pohjoisella alueella merkitsevästi korkeampi kuin eteläisellä. Hampaattomuus oli yleisempää vähiten koulutusta saaneilla kuin korkeamman koulutuksen saaneilla. Hampaallisilla oli pienempi alaleuan leukakulma kuin hampaattomilla, ja heillä oli myös korkeampi nouseva haara ja nivellisäke kuin hampaattomilla. Naisilla oli merkitsevästi useammin vakavaa hammasharjanteen madaltumista kuin miehillä. Molemmilla sukupuolilla tyytymättömyys proteeseihin liittyi merkitsevästi huonoon purentatasapainoon. Yli kolmella neljäsosalla tutkituista oli vakava tulehdusriski, eteläisellä alueella enemmän kuin pohjoisella. Hampaallisessa aineistossa naisilla oli enemmän kiinteitä proteeseja kuin miehillä. Kirkkonummen alueella tutkituilla oli enemmän kiinteitä proteeseja kuin Lakeuden alueella. Hampaattomuus oli hyvin yleistä 60–78-vuotiailla suomalaisilla. Alaleuanluun muoto muuttui hampaiden menetyksen seurauksena. Kiinteiden proteesien määrä oli vähäinen ja ikääntyvillä suomalaisilla oli röntgenkuvissa runsaasti hammasperäisten tulehdusten löydöksiä. Suun terveyden alueelliset erot tulisi ottaa huomioon suu- ja hammasterveyden edistämistyössä, jossa erityisesti tulisi huomioida alhaisen sosioekonomisen aseman ja huonon terveyden omaava vanhempi väestö.