O presente trabalho se propôs a fazer uma avaliação da higiene e saúde orais de pacientes geriátricos portadores de próteses totais. Devido ao crescimento da população idosa houve um aumento do número de pacientes que passaram a usar algum tipo de prótese (total, removível ou implantes). Espera-se que as próteses totais restituam as funções estéticas, mastigatórias e fonéticas, no entanto sua instalação não representa o final da reabilitação protética, existindo a necessidade da realização de controles periódicos. Um dos fatores essenciais para o sucesso do tratamento odontológico é a higienização eficiente, capaz de remover o biofilme das próteses. Em casos de estomatite protética associada à Cândida ssp, as medidas terapêuticas mais eficientes são os controles efetivos da higiene oral, assim como das próteses (HEARTWELL; RAHN, 1993). Partindo desse raciocínio, o índice de placa nas faces interna e externa das próteses totais maxilares foi avaliado, neste trabalho, através do uso de evidenciadores. Esse procedimento foi realizado em próteses novas tendo-se a preocupação de orientar, no momento da instalação, os portadores das mesmas sobre cuidados de higienização da cavidade oral e das próteses. Foi realizado ainda exame citológico do palato desses mesmos pacientes a fim de verificar a presença de Cândida albicans. Os resultados encontrados não mostraram diminuição dos índices de biofilme depositados nas próteses totais maxilares tanto dos pacientes do grupo experimental como dos pacientes do grupo controle, sendo que se procurou avaliar também distúrbios cognitivos. Estes resultados sugerem que o método de motivação não foi eficiente e que fatores psicológicos, sociais e culturais influenciam a motivação dos pacientes em relação a hábitos de saúde oral. / This research intended to evaluate hygiene and oral health in geriatric patients using complete dentures. Because the elderly population has increased fast much more people uses today some kind of prostheses (complete, removable or implants). It’s expected that complete dentures should replace facial expression, mastigatory function and speech as well. However this is not always possible because patients are supposed to accept the inconvenience and responsibility of taking care of their own prostheses. A very important step is to perform a good hygiene intending to control biofilm development on tooth surface as well as over the prostheses. In Candida-associated denture stomatites the most important therapeutic measure is institution of effective oral and denture hygiene (HEARTWELL; RAHN, 1993). Based on what was mentioned before it was analyzed by means of staining, the biofilm index in the internal and external faces of complete dentures. Such procedures were performed in the new prostheses after instructing the patient how to clean them. It was also performed a cytologic exam of the palatal mucosa to verify if Candida albicans were present, or not. The results did not show any diminution of the biofilm index accumulate in the maxillary prostheses of both groups: control and experimental with or without deficit of cognition. Such results suggest that the motivation method was not efficient and also that psychologic, social and cultural factors do influence the patient’s motivation when we deal with oral health.

O presente trabalho se propôs a fazer uma avaliação da higiene e saúde orais de pacientes geriátricos portadores de próteses totais. Devido ao crescimento da população idosa houve um aumento do número de pacientes que passaram a usar algum tipo de prótese (total, removível ou implantes). Espera-se que as próteses totais restituam as funções estéticas, mastigatórias e fonéticas, no entanto sua instalação não representa o final da reabilitação protética, existindo a necessidade da realização de controles periódicos. Um dos fatores essenciais para o sucesso do tratamento odontológico é a higienização eficiente, capaz de remover o biofilme das próteses. Em casos de estomatite protética associada à Cândida ssp, as medidas terapêuticas mais eficientes são os controles efetivos da higiene oral, assim como das próteses (HEARTWELL; RAHN, 1993). Partindo desse raciocínio, o índice de placa nas faces interna e externa das próteses totais maxilares foi avaliado, neste trabalho, através do uso de evidenciadores. Esse procedimento foi realizado em próteses novas tendo-se a preocupação de orientar, no momento da instalação, os portadores das mesmas sobre cuidados de higienização da cavidade oral e das próteses. Foi realizado ainda exame citológico do palato desses mesmos pacientes a fim de verificar a presença de Cândida albicans. Os resultados encontrados não mostraram diminuição dos índices de biofilme depositados nas próteses totais maxilares tanto dos pacientes do grupo experimental como dos pacientes do grupo controle, sendo que se procurou avaliar também distúrbios cognitivos. Estes resultados sugerem que o método de motivação não foi eficiente e que fatores psicológicos, sociais e culturais influenciam a motivação dos pacientes em relação a hábitos de saúde oral. / This research intended to evaluate hygiene and oral health in geriatric patients using complete dentures. Because the elderly population has increased fast much more people uses today some kind of prostheses (complete, removable or implants). It’s expected that complete dentures should replace facial expression, mastigatory function and speech as well. However this is not always possible because patients are supposed to accept the inconvenience and responsibility of taking care of their own prostheses. A very important step is to perform a good hygiene intending to control biofilm development on tooth surface as well as over the prostheses. In Candida-associated denture stomatites the most important therapeutic measure is institution of effective oral and denture hygiene (HEARTWELL; RAHN, 1993). Based on what was mentioned before it was analyzed by means of staining, the biofilm index in the internal and external faces of complete dentures. Such procedures were performed in the new prostheses after instructing the patient how to clean them. It was also performed a cytologic exam of the palatal mucosa to verify if Candida albicans were present, or not. The results did not show any diminution of the biofilm index accumulate in the maxillary prostheses of both groups: control and experimental with or without deficit of cognition. Such results suggest that the motivation method was not efficient and also that psychologic, social and cultural factors do influence the patient’s motivation when we deal with oral health.

Orientador: Eduardo Hebling / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-12T07:54:32Z (GMT). No. of bitstreams: 1 Coutinho_LorenaAlves_M.pdf: 1135268 bytes, checksum: e47d5b9869b01e8a35af855f67d41a1d (MD5) Previous issue date: 2008 / Resumo: O envelhecimento populacional e o desenvolvimento de uma filosofia preventiva no atendimento odontológico fazem com que um número maior de pessoas alcance idade avançada, mantendo a sua dentição. O processo de envelhecimento humano proporciona uma série de alterações anatômicas, fisiológicas e sociais nos pacientes que devem ser consideradas no atendimento odontológico. O objetivo deste estudo foi determinar a condição endodontica de pacientes idosos. Foram avaliados 942 dentes em 81 idosos, com idade acima de 60 anos, funcionalmente independentes ou parcialmente dependentes, com o mínimo de 3 dentes presentes na cavidade bucal, residentes em duas instituições da cidade de Piracicaba-SP, Brasil. Foram realizados exame clínico, radiográfico e testes complementares de vitalidade pulpar. Os resultados foram avaliados por estatística descritiva. A maioria dos dentes avaliados não apresentou lesões endodônticas, porém quando avaliados os dentes com canais tratados endodonticamente constatou-se uma alta prevalência de lesões apicais nestes dentes. Houve correlação entre canais endodonticamente tratados e lesões apicais decorrentes da qualidade dos tratamentos endodônticos. A prevalência de calcificações pulpares e dos canais radiculares observada na amostra foi elevada. Em conclusão, a alta prevalência de calcificações pulpares e dos canais radiculares, de lesões apicais e de necessidade de retratamentos endodônticos fazem com que a demanda por serviços de endodontia em idosos permaneça elevada. / Abstract: The ageing population and the development of a philosophy in preventive dental care are such that a larger number of people reaching old age while maintaining their teeth. The process of human aging provides a series of anatomical, physiological and social alterations in patients that should be considered in dental care. The aim of this study was to determine the endodontic status in elderly patients. 942 teeth were evaluated in 81 elderly patients, aged above 60 years, functionally independent or partly dependent, showed a minimum of 3 teeth in the mouth, residents in two institutions in the city of Piracicaba-SP, Brazil. The clinical trial and radiographic and pulp vitality examination were conducted. The data were evaluated through the descriptive statistic. The results showed that most of the teeth evaluated endodontic showed no injuries, but when evaluated the teeth with root canal treatment there was a high prevalence of apical injuries. There was correlation between root canal treatment and periodontitis apical and injuries due to the quality of endodontic treatments. The prevalence of canal and pulp calcifications observed was high. In conclusion, the high prevalence of canal and pulp calcifications, apical injuries, and need for endodontic treatment will be doing that demand for endodontic care stay elevated. / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Orientador: Eduardo Hebling / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T21:15:42Z (GMT). No. of bitstreams: 1 Souza_SilviaFerreirade_M.pdf: 622832 bytes, checksum: e711ade5c26d35edfa9b7f9cb5a5d983 (MD5) Previous issue date: 2011 / Resumo: O aumento da longevidade da população mundial faz com que a expectativa de manutenção da dentição possa ser observada em idosos. Esse fato pode acarretar em aumento da prevalência das doenças periodontais nessa população. O objetivo desse estudo foi avaliar a condição periodontal de idosos institucionalizados. Foram utilizados dados secundários provenientes de estudo anterior. Foram avaliados os exames radiográficos periapicais padronizados obtidos de uma amostra de 70 pessoas, de ambos os gêneros, com idade acima de 65 anos, funcionalmente independentes ou parcialmente independentes, com o mínimo de 6 dentes em ambas as arcadas, residentes em duas instituições da cidade de Piracicaba-SP, Brasil. As radiografias foram avaliadas por um examinador calibrado (Kappa > 85%), em ambiente escuro, com uso de lupa, negatoscópio e paquímetro digital. O Nível Ósseo Marginal (NOM) interproximal foi utilizado como parâmetro de avaliação. Os dados foram avaliados pelos testes de Wilcoxon e Kruskal-wallis. A prevalência de reduzido NOM foi alta, influenciando a expressiva perda dentária observada entre os idosos. Nenhuma diferença na distribuição do NOM entre os grupos de dentes foi observada. Futuras ações e políticas de saúde devem ser desenvolvidas para melhorar a condição periodontal para essa população / Abstract: The increase in longevity of the world population makes the expectation of maintenance of dentition can be observed in the elderly. This fact may result in increased prevalence of periodontal diseases in this population. The aim of this study was to evaluate the periodontal condition of institutionalized elderly. Secondary data from a previous study were used. Standardized periapical radiographic exams obtained from a sample of 70 subjects, both genders, aged above 65 years, functionally independent or partially independent, with a minimum of 6 teeth in both the arcades, residing in two institutions of the city of Piracicaba-SP, Brazil, were assessed. The radiographs were evaluated by a calibrated examiner (Kappa > 85%), in environment dark, using loupe, negatoscópio and digital caliper. Interdental Marginal Bone Level (MBL) was used as assessed parameter. The data were assessed by means of Wilcoxon and Kruskal-wallis tests. The prevalence of reduced MBL was high, influencing the expressive tooth loss among the elderly. No difference in a distribution of the MBL between the teeth groups was founded. Further preventive actions and health politics have been developed for improve the periodontal status for this population / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Background: The Program of All-inclusive Care for the Elderly (PACE) is a program of care that enrolls nursing home eligible and offers them community-based long-term services and supports (LTSS). Many PACE enrollees are “dual eligibles” (DEs) meaning they qualify for Medicare and Medicaid services. Dental care is a unique feature of PACE among LTSS, as many LTSS do not include dental care, even though this population has difficulty in accessing these services. However, little is known about the delivery of dental care at PACE and how dental care and oral health promotion and prevention is being integrated into PACE. Thus, the purpose of this study is to describe the delivery and integration of dental care at PACE. Methods: Based on ten preliminary interviews and the PACE manual from the Centers for Medicare and Medicaid Services (CMS), a 56-question survey was developed to describe the delivery and integration of dental care at PACE across the country. In addition, the survey asked programs to rank their focus among five specialties (dentistry, mental health, optometry, audiology, podiatry), to determine if a program’s focus on dental care would influence the delivery and integration of dental services at PACE, and if this would lead the program to have a very high percentage of new and continuous enrollees with regular dental examinations. A publicly available contact list was obtained from CMS and the survey was distributed to all 124 PACE programs via email. Results: Respondents in this study represented 35 programs (28.2%) in 23 states (74.2%). Most programs had no limits for dental care, minimal waitlists, and provide most dental services without exclusions. This is evident by the 51.4% of programs that have no dental budget, 100% of programs providing preventive and basic restorative dental care, and nearly 100% offering advanced restorative services. Many programs also did not have a waitlist for non-emergent dental care. Few programs include a dentist in the routine operations of the PACE program, as evidenced by few programs having dentists conduct the dental assessment for the initial comprehensive assessment or having a dental director. A statistically significant association with a high percentage of reported utilization of dental examinations was detected with programs having a system for quality assurance for dental care (t=0.358, p=0.024), a protocol for a dental cleaning every 6-12 months (t=0.595, p<0.001), mandating a comprehensive dental examination (t=0.390, p=0.007), and providing preventive dental services onsite with built-in equipment (t=0.454, p=0.001). No factors were statistically associated with the focus ranking for dentistry among the other specialties. Conclusion: This study suggests that compared to nursing homes, PACE enrollees may have greater ability to receive dental care without limitations of the state adult Medicaid dental benefit. Dentistry also appears to be a high focus for some PACE programs. This study has begun to identify structures that support positive outcomes that can be used to develop best practices and guidelines for the delivery of dental care in PACE and other LTSS. Future studies are needed to better understand barriers and facilitators to the delivery of dental care and other specialty services.

Ältere und auch pflegebedürftige Menschen werden den Alltag in den Zahnarztpraxen in den kommenden Jahren immer stärker prägen. Mit zunehmender Gebrechlichkeit der Betagten und Hochbetagten sollte sich die zahnmedizinische Behandlung in eine zahnmedizinische Betreuung wandeln. Auch bei einer, im Vergleich zu früher, später eintretenden Pflegebedürftigkeit sind in der Zukunft bei vielen Pflegebedürftigen die zweiten und dritten Zähne zu versorgen. Leider ist festzustellen, dass die zahnmedizinische Versorgung in Pflegeeinrichtungen noch nicht ausreichend standardisiert ist. Von den Pflegebedürftigen in Sachsen, Berlin und Nordrhein Westfalen besaßen nur 18,6 % stationär Pflegebedürftige und 41,2 % ambulant Pflegebedürftige ein zahnmedizinisches Bonusheft. Die Verteilung war regional sehr unterschiedlich. Anteilig besaßen die Pflegebedürftigen in Sachsen am häufigsten ein Bonusheft. Das Vorhandensein des Bonusheftes war weder von Alter oder Geschlecht abhängig. Der Verlust einer besseren Bonusregelung bei Zahnersatzleistungen wird dabei von den Pflegedienstleitungen und dem medizinischen Dienst völlig außer Acht gelassen, teilweise sind die Bonusregelungen auch nicht ausreichend bekannt. Die Organisation eines kontinuierlichen Konsildienstes könnte mit der Anforderung an das Führen eines zahnmedizinischen Bonusheftes verbessert werden. Hierzu müssen aber die Informationen zum Bonusheft gezielt an die Heimleitungen, die Heimaufsichten, die Heimräte, die Angehörigen und an den medizinischen Dienst herangetragen werden.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.

OBJECTIVE: To understand dental service utilization by frail older adults residing in a long-term care (LTC) setting in the last two years of their life. To understand the types of dental services utilized by this demographic, the frequency of utilization and determine the characteristics that may be predictors of ‘higher dental service utilization’. METHODS: A retrospective cohort study was conducted by an electronic chart review of all LTC patients at two sites who died between 11/1/2014 - 12/30/2016 and had a dental visit in the two-year period prior to death, resulting in a sample of 369 patients. Based on the number of dental appointments attended prior to death, the patients were categorized into five groups: 0,1-2,3-5,6-9 and10 or more appointments. A multivariate logistic regression model was created to identify the factors associated with higher dental service utilization. RESULT: The study found that 84% of patients who died in the study period, utilized on-site dental services in the last two years of their life. Approximately 66% had 3 or more dental appointments. Diagnostic and preventive procedures were most commonly utilized (utilized by 81% and 73% of patients respectively). Multivariate analysis suggested that dentate patients and patients wearing removable dental prosthesis were about 7 and 12 times more likely respectively to have a higher utilization of dental services (OR=6.5 and OR=11.7). Medicaid beneficiaries were more likely (OR=1.9) to have a higher utilization of dental services than the others. CONCLUSIONS: This study showed that a large percentage of frail older adults utilized dental services even in the last years of their lives when given access to these services. As people are living longer and retaining their teeth longer, there is a rising need and subsequent demand for end-of-life dental services. Certain administrative and policy implementation strategies need to be developed to provide dental services to LTC patients in the last years of their lives.

Poucos estudos analisam a associação entre saúde bucal e qualidade de vida geral com um delineamento longitudinal. O objetivo do presente estudo foi avaliar se mudanças no estado de saúde bucal estiveram associadas com o declínio nos escores dos domínios do instrumento WHOQOL-bref. Este estudo longitudinal foi parte de uma coorte de idosos independentes vivendo no sul do Brasil. Uma amostra de 872 indivíduos com mais de 60 anos foi avaliada na linha de base em 2004. O seguimento aconteceu em 2012, sendo que a população para o presente estudo foi de 389 idosos. Entrevistas foram realizadas para coletar dados sociodemográficos, qualidade de vida (WHOQOL-bref) e sintomas depressivos (Escala de Depressão Geriátrica). Exames bucais com contagem de dentes foram realizados. Os participantes avaliaram sua satisfação com capacidade mastigatória e aparência oral. Riscos relativos foram estimados através de regressão de Poisson. Recuperação de sintomas depressivos foi um fator de proteção para declínio no escore dos domínios físico (RR 0,49 (0,30-0,80)), psicológico (RR 0,38 (0,20-0,73)), social (RR 0,52 (0,35- 0,76)) e ambiental (RR 0,31 (0,16-0,60)). No domínio físico, diminuição no número de doenças crônicas (RR 0,60 (0,40-0,88)) também esteve associado à qualidade de vida. Quanto ao domínio psicológico, melhora na satisfação com a capacidade mastigatória (RR 0,69 (0,50-0,97)) e perda dentária (RR 1,04 (1,02-1,06)) estiveram relacionados com o desfecho. No domínio social, morar na área rural (RR 1,11 (1,01- 1,23)) a aumento na satisfação com aparência bucal (RR 0,84 (0,72-0,98)) estiveram associados com a qualidade de vida. As mesmas variáveis estiveram associadas no domínio ambiental, a RR 1,24 (1,06-1,44) e RR 0,77 (0,61-0,97) respectivamente. Os resultados indicam que prevenir a perda dentária e reconhecer e tratar apropriadamente das necessidades do paciente no que diz respeito à capacidade mastigatória e aparência bucal pode ter impacto no bem-estar geral de idosos independentes. / Few studies assess the association between oral health and general quality of life (QoL) in a longitudinal design. The aim of this study was to evaluate if changes in oral health status were associated with decline in WHOQOL-bref domain scores. This longitudinal study was part of a cohort of community dwelling elderlies in southern Brazil. A random sample of 872 individuals aged 60 or more was evaluated at baseline in 2004. Follow-up was carried out in 2012, with the population for the current study consisting of 389 elderlies. Interviews were performed to assess sociodemographic data, qol (WHOQOL-bref) and depressive symptoms (Geriatric Depression Scale). Oral examinations assessing the number of teeth were performed. Subjects were asked to rate their satisfaction with chewing ability and oral appearance. Risk ratios were estimated by means of Poisson regression. Recovery from depressive symptoms was a protective factor to decline in WHOQOL scores in the physical (RR 0.49 (0.30-0.80)), psychological (RR 0.38 (0.20-0.73)), social (RR 0.52 (0.35-0.76)) and environment (RR 0.31 (0.16-0.60)) domains. In the physical domain, decrease in number of chronic conditions (RR 0.60 (0.40-0.88)) was also associated. Regarding the psychological domain, improvement in satisfaction with chewing ability (RR 0.69 (0.50-0.97)) and tooth loss (RR 1.04 (1.02-1.06)) were also related to qol. In the social domain, living in rural area (RR 1.11 (1.01-1.23)) and increased satisfaction with oral appearance (RR 0.84 (0.72-0.98)) were associated to the outcome. The same variables were associated with the environment domain, at RR 1.24 (1.06-1.44) and RR 0.77 (0.61-0.97). The results indicate that preventing tooth loss and recognizing and properly addressing the patient’s concern regarding chewing and dental appearance can have an impact in the general well-being of community dwelling older adults.