Data on the oral health of the elderly depict a worrying situation, with an elevated prevalence of caries and moderate periodontal disease, frequent edentulism, and numerous cases of dry mouth and oral cancer. There is wide evidence that periodontitis is a risk factor for certain systemic diseases, and impaired oral health has been associated with mastication and nutritional problems, especially among the elderly, with highly negative effects on their quality of life. In this nonsystematic review, the authors discuss the importance of evaluating the oral health of the geriatric population in a comprehensive manner, beyond simple clinical assessments.

Background. Dementia is a multi-etiologic syndrome characterized by multiple cognitive deficits but not always by the presence of cognitive impairment. Cognitive impairment is associated with multiple non-modifiable risk factors but few modifiable factors. Epidemiological studies have shown an association between periodontitis, a potentially modifiable risk factor, and cognitive impairment.Objectives. To determine whether clinical periodontitis is associated with the diagnosis of cognitive impairment/dementia after controlling for known risk factors, including age, sex, and educational level.Methods. A case-control study was conducted in Granada, Spain, in two groups of dentate individuals over 50 years of age: cases with a firm diagnosis of mild cognitive impairment or dementia of any type or severity, and controls with no subjective memory loss complaints and a score >30 in the "Phototest" cognitive test (screening test for cognitive impairment). Periodontitis was evaluated by measuring tooth loss, plaque and bleeding indexes, pocket depths, and clinical attachment loss.Results. The study included 409 dentate adults, 180 with cognitive impairment and 229 without. A moderate and statistically significant association was observed between clinical attachment loss and cognitive impairment after controlling for age, sex, educational level, oral hygiene habits, and hyperlipidemia (p=0.049). No significant association was found between tooth loss and cognitive impairment.Conclusion. Periodontitis appears to be associated with cognitive impairment after controlling for confounders such as age, sex, and educational level. KEY WORDS.Periodontitis, periodontal attachment loss, mild cognitive impairment, dementia.Dementia is a multi-etiologic syndrome characterized by the acquired involvement of multiple cognitive/behavioral domains that compromise the sufferer's functional capacity 1 . It largely affects the elderly, although it can commence at any age 1 . Mild cognitive impairment is an intermediate state, frequently appearing before the development of dementia, in which the cognitive and behavioral impairment is not sufficiently severe to have functional repercussions 2 . The main cause of dementia is Alzheimer's Disease (AD), a neurodegenerative process of multifactorial and complex etiology associated with multiple risk and protective factors; its prevalence increases exponentially with age from 65 years on, and it represents one of the main socio-health problems faced by the developed world 3 . It is estimated that there will be 35.6 million individuals with dementia worldwide in 2010 and that this number will double every 20 years, reaching more than 115 million by 2050 1 . The magnitude of the challenge and the 1 Journal of Periodontology; absence of curative treatments make the development of preventive measures a matter of extreme urgency. Although many risk factors are non-modifiable (e.g., age, sex, and genetic risk factors), others are susceptible to modification through individual choices, e.g., certain dieta...

Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis (Review)

Aim To evaluate the prevalence of peri‐implant diseases in Spain, as well as the associated risk indicators. Material and Methods This is a cross‐sectional study using a network of sentinel dentists, who randomly selected 10 patients with implants (placed, at least, 5 years before), which were clinically and radiographically evaluated. Case definitions were established for peri‐implant mucositis [bleeding on probing (BOP) and no bone level ≥2 mm] and peri‐implantitis (BOP plus bone level ≥2 mm). Potential predictor variables, at univariate and multivariate levels, were explored by means of binary logistic regression. Results A total of 49 sentinel dentists provided complete data from 474 implants in 275 patients. At implant level, prevalences for peri‐implant mucositis and peri‐implantitis were 27% (95% confidence interval [CI] 22–32) and 20% (95% CI: 15–24), respectively, with 17% of implants (14–21) with bone level ≥2 mm without BOP. At patient level, prevalences were 27% (22–32), 24% (19–29) and 18% (13–22), respectively. In the multiple regression analysis, statistically significant associations for peri‐implantitis (p < 0.10) were found for gender, peri‐implant supportive therapy, implant location, diameter and surface, type of prosthesis and access to interproximal hygiene. Conclusions In this representative subject sample across Spain, the prevalence of peri‐implant diseases was high (51%).

The prevalence of peri-implant inflammatory disease in periodontal patients who regularly undergo SPT is clinically significant. The factors associated with peri-implant inflammatory disease were plaque index and implant location, and mucositis was also affected by the type of periodontitis the patient had.

BackgroundOral health-related quality of life (OHQoL) is conceived as a multidimensional construct. Here our aim was to investigate the dimensional structure of OHQoL as measured by the Spanish versions of the Oral Impacts on Daily Performance (OIDP) and the Oral Health Impact Profile (OHIP-14) questionnaires applied simultaneously.MethodsWe recruited a consecutive sample of 270 healthy Spanish workers visiting the Employment Risk Prevention Centre for a routine medical check-up. OHIP-14 was self-completed by participants but the OIDP was completed in face-to-face interviews. An Exploratory Factor Analysis (EFA) was performed to identify the underlying dimensions of the OHQoL construct assessed by both instruments. This factorial structure was later confirmed by Confirmatory Factor Analysis (CFA) using several estimators of goodness of fit indices.ResultsEFA and the CFA identified and respectively confirmed a set of 3 underlying factors in both questionnaires that could be interpreted as functional limitation, pain-discomfort, and psychosocial impacts. The model achieved was seen to fit properly for both instruments, but the factorial structure was clearer for the OIDP.ConclusionsThe results provide evidence for construct equivalence in the latent factors assessed by both OIDP and OHIP-14, suggesting that OHQoL is a three-dimensional construct. The prevalence of impact on these three factors was coherent between both indicators, pain-discomfort having the highest prevalence, followed by psycho-social impact, and functional limitation.

BackgroundOral health-related quality of life can be assessed positively, by measuring satisfaction with mouth, or negatively, by measuring oral impact on the performance of daily activities. The study objective was to validate two complementary indicators, i.e., the OIDP (Oral Impacts on Daily Performances) and Oral Satisfaction 0–10 Scale (OSS), in two qualitatively different socio-demographic samples of the Spanish adult population, and to analyse the factors affecting both perspectives of well-being.MethodsA cross-sectional study was performed, recruiting a Validation Sample from randomly selected Health Centres in Granada (Spain), representing the general population (n = 253), and a Working Sample (n = 561) randomly selected from active Regional Government staff, i.e., representing the more privileged end of the socio-demographic spectrum of this reference population. All participants were examined according to WHO methodology and completed an in-person interview on their oral impacts and oral satisfaction using the OIDP and OSS 0–10 respectively. The reliability and validity of the two indicators were assessed. An alternative method of describing the causes of oral impacts is presented.ResultsThe reliability coefficient (Cronbach's alpha) of the OIDP was above the recommended 0.7 threshold in both Validation and Occupational samples (0.79 and 0.71 respectively). Test-retest analysis confirmed the external reliability of the OSS (Intraclass Correlation Coefficient, 0.89; p < 0.001) Some subjective factors (perceived need for dental treatment, complaints about mouth and intermediate impacts) were strongly associated with both indicators, supporting their construct and criterion validity. The main cause of oral impact was dental pain. Several socio-demographic, behavioural and clinical variables were identified as modulating factors.ConclusionOIDP and OSS are valid and reliable subjective measures of oral impacts and oral satisfaction, respectively, in an adult Spanish population. Exploring simultaneously these issues may provide useful insights into how satisfaction and impact on well-being are constructed.

Objectives: The purposes of this study are to validate the indicator of Oral Health Impact Profile for edentulous patients (OHIP-20sp) in the Spanish population and to analyze the factorial construct of the prosthetic well-being. Study Design: A total of twenty-one (n=21) edentulous patients wearing mandibular implant-over dentures on Locator® (LO) and twenty (n=20) with complete dentures (CD) were retrospectively evaluated in this study. All participants were recruited consecutively and were treated in the previous academic year 2009-2010 by professors of the University of Salamanca. Reliability analyses and validity tests were performed in order to evaluate the psychometric properties of OHIP-20sp employing two different total score methods (additional and simple count). A retrospective evaluation of the impact of the prosthetic treatment was captured with an evaluative instrument derived from OHIP-20, and named POST-OHIP-13. Results: The reliability coefficient (Cronbach’s alpha = 0.91) has shown a high internal consistency. Item-total correlations coefficients ranged from 0.46 and 0.81. Five factors, named as disability, functional comfort, psychosocial impact, pain-discomfort and functional limitations were identified as principal components of the construct, explaining almost 85% of the variance. The 48% of the sample felt at least one impact in an occasional or more frequently manner (generally food packing). The global transition judgment of the prosthetic treatment using the POST-OHIP-13 was significantly higher in group LO than in the CD group. Conclusions: OHIP-20 seems to be a reliable and valid indicator to measure oral impact and satisfaction in the Spanish edentulous population. The underlying construct is comprised by 5 factors named as disability, functional comfort, psychosocial impact, pain-discomfort and functional limitations. Key words:Oral health-related quality of life, edentulous, satisfaction, validation.