1) There is fair evidence (II-2, grade B recommendation) of an association of pneumonia with oral health (odds ratio [OR]=1.2 to 9.6 depending on oral health indicators). 2) There is poor evidence of a weak association (OR<2.0) between COPD and oral health (II-2/3, grade C recommendation). 3) There is good evidence (I, grade A recommendation) that improved oral hygiene and frequent professional oral health care reduces the progression or occurrence of respiratory diseases among high-risk elderly adults living in nursing homes and especially those in intensive care units (ICUs) (number needed to treat [NNT]=2 to 16; relative risk reduction [RRR]=34% to 83%).

This study examined risk indicators and risk markers for periodontal disease experience in 624 adults aged 50 years and over living independently in four communities in Ontario, Canada. The data were collected as part of the baseline phase of a longitudinal study of the oral health and treatment needs of this population. Periodontal disease experience was assessed in terms of attachment loss, measured at two sites on each remaining tooth. Bivariate and multivariate analyses were used to examine the relationship between a number of sociodemographic, general health, psychosocial, and oral health variables and three indicators of periodontal disease experience. These were: mean attachment loss, the proportion of sites examined with loss of 2 mm or more, and the probability of the subjects having severe disease, arbitrarily defined as a mean attachment loss in the upper 20th percentile of the distribution. Mean attachment loss was 2.95 mm (SD = 1.41 mm), and 76.6% of sites examined had loss of 2 mm or more. In bivariate analyses, the most consistent predictors of periodontal disease experience were: age, education, income, smoking, dental visiting, the number of remaining teeth, the number of decayed coronal surfaces, and the number of decayed root surfaces. In multivariate analyses, age, education, current smoking status, and the number of teeth had the most consistent independent effects. These data confirm the results of recent US studies indicating that periodontal disease experience is influenced by social and behavioral factors.

Although the majority of paediatricians and family physicians reported including aspects of oral health in children's well visits, a reported lack of dental knowledge and training appeared to pose barriers, limiting these physicians from playing a more active role in promoting the oral health of children in their practices.

This study was carried out to develop and test an index of chewing ability suitable for epidemiologic surveys. Existing data on older adults living independently in East York, Ontario, were reanalyzed and the index was developed using techniques of scalogram analysis. Individuals were scored from 0 to 5 based on their self-reported ability to chew the most difficult of five foods. In this representative sample, 77 percent scored 5. The index has high predictive values when compared to two other questions on chewing ability in the survey. Among those with chewing disability (scoring 0 to 4), the odds ratio (OR) for being edentulous was 4.1 (95%) Cl = 2.1-8.3). No factor influenced chewing ability among the edentulous. Among the dentate, several clinical dental health status measures appeared to influence chewing ability. Logistic analysis identified the absence of functioning opposing pairs of natural posterior teeth, OR 5.6 (95% Cl = 2.21-14.39), and the need for urgent care, OR 23.7 (95% Cl = 1.05-6.95), as the most important.

Data on the incidence of tooth loss in community-dwelling older Canadians have not previously been reported. Since recent US studies of older adults were conducted in predominantly rural communities, their results may not be generalizable to Canada, where the majority of older adults live in major metropolitan or urban settings. This paper describes a study designed to estimate the incidence of tooth loss in older Canadians and to identify factors predictive of that loss. Using personal interviews and clinical examinations, we obtained baseline and three-year follow-up data from 491 dentate subjects. Overall, 23.2% lost one or more teeth between baseline and follow-up. Only six, or 1.2%, became edentulous. Twelve baseline factors were significantly associated with the probability of loss. However, in a logistic regression analysis, only five had significant independent effects. These were gender, marital status, self-rating of oral health status, the number of decayed root surfaces, and a mean periodontal attachment loss of 4 mm or more. The predictive ability of the model was poor, largely because tooth loss is a complex outcome which depends on decisions taken by dentists and patients. Since this decision-making process cannot be captured in epidemiological studies, observational studies are needed to cast further light on tooth loss in this population.

We conducted a case-control study to determine the sources of fluoride which are particular risk factors to dental fluorosis. Cases and non-cases were identified by the screening of 8-, 9-, and 10-year-old schoolchildren in the fluoridated community of East York, Ontario. Parents were interviewed about the child's first five years of residence and about diet and preventive caries practices. The Mantel-Haenszel odds ratio and associated chi-square tests were used to assess the association of fluorosis with several potential sources, controlling for other sources of fluoride and mother's education. The prevalence of mild fluorosis [1-4 on the Thylstrup and Fejerskov (1978) Index] was 13%. Those who brushed their teeth before the age of 25 months had 11 times the odds of fluorosis compared with those beginning toothbrushing later; prolonged use of infant formula (greater than or equal to 13 months) was associated with 3.5 times the risk of fluorosis, compared with no, or shorter duration of, formula use. We estimate that these factors were responsible for 72% and 22%, respectively, of the cases in our population. Dental fluorosis is not a public health problem in East York, but parents should be advised to supervise toothbrushing by children under 2 years of age.

The number of teeth needed to maintain adequate dental function in older adults is unknown. The purpose of this study was to examine the relationship between oral function and the number of opposing pairs of posterior teeth. We identified 338 subjects with complete anterior dentitions from an interview and examination survey of Ontario adults aged 50 and over; 261 had no partial denture and 77 had removable partial dentures (RPD). Oral function was measured using questions assessing chewing ability, mandibular function and socio-psychological impact. Subjects with no partial dentures were further allocated to five groups, based on their dental status: complete dental arch (n = 69); 5-7 functional units-pairs of opposing posterior teeth (n = 109); 3 or 4 functional units (n = 48) and 0-2 functional units (n = 35). Oral function problems increased with decreasing functional units being markedly more prevalent among the groups with 0-2 functional units. 34% of subjects in the 0-2 group reported one or more problems with chewing ability compared to 6-17% in the other groups (chi 2 P = 0.001 d.f. = 3). The 77 subjects who wore removable partial dentures, reported social and dental function at levels comparable to those with no dentures. From these results, there appears to be little socio-functional need to replace lost posterior teeth with a partial denture unit the person has fewer than, 3 posterior functional units. The low number of partial denture wearers limited our ability to detect a lasting benefit from RPD treatment.

Our results indicate that dental caries and ECC are highly prevalent in this population, with ECC cases having 6.7 more dmft than non-cases.