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This article describes the rapidly growing geriatric population in the United States. Current and emerging living arrangements include the subgroups of older adults who live at home, retirement villages, assisted living facilities, various levels of nursing homes, and hospice care. The degree of isolation and social connection is discussed and the need for dental care has been summarized from the literature. Demographic trends imply a substantial increase in both the need and demand for dental care by the senior age groups. A proposal to integrate oral health and dental care with primary care is provided.

The population of the United States is aging rapidly, and the prevalence of chronic diseases will increase as the population grows and ages. The management of chronic illnesses will become an increasing burden for primary care providers. This article suggests that dentists may need to monitor chronic disease and control the risk factors (ie, provide primary care) for their own dental patients.

Normal function of Insulin-like Growth Factor II Receptor ( IGF2R ) gene has been associated with negative control of tumor growth in vivo and in vitro . Rare alleles at a 3′ UTR short tandem repeat polymorphism of IGF2R are known to decrease transcript stability. One such allele ( A2/B2 ) increases significantly the risk of oral squamous cell carcinoma and non-small cell lung carcinoma (NSCLC) in Caucasians. To determine potential association(s) between A2/B2 presence and development and/or progression of disease, we examined in 103 NSCLC patients, free of IGF2R allelic imbalance aberrations, the 3′ UTR allelic status in relation to tumor kinetic parameters (proliferation index-PI and apoptotic index-AI) and clinicopathological data. PCR and automated sequence analyses were employed to genotype the IGF2R 3′ UTR polymorphism. Given that, oncogenic mitogens, which escape degradation by IGF2R , can also activate p53 through a DNA damage response, the patterns between p53 status and IGF2R genetic constitution were also evaluated in relation to the above parameters. The A2/B2 variant was significantly more common ( p = 0.005, χ 2 -test) in lung cancer patients (25% vs 15%). Its presence was accompanied by high cellular proliferation ( p = 0.028, t -test) along with increased tumor cell growth (GI = PI/AI) ( p = 0.022, t -test) and it was significantly found in advanced stages. Also, patients carrying the A2/B2 in their genetic constitution that exhibit aberrant p53 expression have faster growing tumors and progress more rapidly to advanced stages. In conclusion, the IGF2R-A2/B2 variant probably provides a selective advantage for NSCLC progression through increased tumor growth.

Background As our understanding of periodontal diseases has increased, it has become clear that certain risk factors are associated with the diseases' incidence, severity and progression. This article focuses on the role of risk assessment and disease management in improving patient outcomes, both in the general population and in specific population groups with an increased risk of developing periodontal disease or with associated comorbidities. Types of Studies Reviewed The author reviewed literature related to the efficacy of risk assessment and periodontal disease management in improving clinical outcomes. In addition, he examined studies demonstrating a link between periodontal disease and specific patient populations and other comorbidities. Conclusions Risk assessment can help predict a patient's risk of developing periodontal disease and improve clinical decision making. In turn, patient adherence to a self-care oral health regimen is a key component to successful periodontal disease management. Clinical Implications The clinical practice of risk assessment may reduce the need for complex periodontal therapy, improve patient outcomes and ultimately reduce oral health care costs. Patients are encouraged to become actively involved in periodontal disease management by following a daily three-step regimen of brushing, flossing and rinsing with an antimicrobial mouthrinse.

Pulpal inflammation is primarily caused by coronal caries, and leads to root canal therapy (RCT). Chronic inflammation has been associated with various cardiovascular diseases. This study evaluates the association between pulpal inflammation (using RCT as a surrogate) and incident coronary heart disease (CHD). We report results among males from the Health Professionals Follow-Up Study (HPFS), excluding participants with prior cardiovascular disease or diabetes. We obtained RCT data from the HPFS cohort (n = 34,683). Compared to men without RCT, those with ≥1 RCT had a multivariate RR of 1.21 (95% CI 1.05-1.40) for CHD. The association was limited to dentists (RR = 1.38; 95% CI 1.14-1.67). There was no association among nondentists (RR = 1.03). Dental caries was not associated with CHD. The results suggest a possible modest association between pulpal inflammation and CHD.

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Objective This paper reviews the existing evidence examining the relationship between periodontal disease, tooth loss, and cardiovascular disease to determine whether tooth extractions reduce the risk of CVD. Study Design All published cohort studies that evaluated both periodontal disease and tooth loss in relation to the risk of coronary heart disease (CHD) or stroke were included in this review. Results Tooth loss appears to be associated with a similar or greater risk for CHD and stroke than does periodontal disease, in all but 1 out of 8 comparisons. The association between periodontal disease and CHD ranges from a relative risk of 1.01 in 1 study to 1.37 in another study after controlling for common risk factors (ie, a 1% to 37% increased risk of CHD among people with periodontal disease compared with those without), whereas the relative risk for tooth loss and CHD ranges from 1.01 to 1.90 across studies (a 1% to 90% increase). The association between periodontal disease and stroke ranges from a relative risk of 1.01 to 2.11, whereas the relative risk for tooth loss and stroke ranges from 1.07 to 1.63 across studies. The associations are modest and similar for both periodontal disease and tooth loss. Conclusion The scientific evidence to date that relates both periodontal disease and tooth loss to CHD and stroke does not support the removal of teeth that have periodontal disease as a means for reducing CVD risk because tooth loss shows a similar association with CVD. J Evid Base Dent Pract 2002;2:261-6

Oral and pharyngeal cancer (OC) mortality is very low in Greece, especially among men, compared to other European countries. We conducted a case-control study of OC in Athens, and obtained information on tobacco, alcohol use and other potential risk factors and confounding variables for 110 incident cases and 115 hospital-based controls. We used multivariate logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Tobacco smoking (packyears, Ptrend=0.01) and alcohol use (drinks/week, Ptrend=0.07) were independent risk factors, with a multiplicative effect for combined exposures (OR, 8.3; 95% CI, 2.4–29.1, for >28 alcohol drinks/week and >50 packyears of cigarette smoking). The type of alcoholic beverage also seemed important: drinking ouzo and tsipouro (liquors of high ethanol concentration) was associated with greater increased OC risk than drinking comparable amounts of wine, beer or dark spirits. While alcohol drinking is more common for male cases versus controls, few men reported regularly consuming large quantities of ethanol associated with highest risk of OC in other studies. This may partially explain the low rates of male OC mortality in Greece. Among the 38% of our cases who were women, however, neither smoking nor alcohol drinking frequencies were significantly elevated compared to controls, and so the etiology of OC risk in females requires further investigation.

A survey of U.S. dentists showed that dental implant use increased 73 percent between 1986 and 1990. More than half of all implants are placed by oral and maxillofacial surgeons. Most dentists who place implants are not affiliated with professional implant organizations; training for implant placement varies widely.

Preventive regimens that have proven efficacy for older adults include topical fluoride rinses, brush-on gels, and antiplaque agents. The efficacy of patient education for both dental office and institutional patients is documented in this article. The use of a preventive and oral health maintenance plan for each patient can improve his or her quality of life even in the face of multiple chronic conditions.

This study by Dr. Sheila McGuire and others not only refutes a link between fluoride ingestion and osteosarcoma formation, but also suggests that fluoride may protect against this cancer. To test the hypothesis that fluoride is a risk factor for osteosarcoma, a case control study compared the complete residential fluoride histories of osteosarcoma patients with matched hospital-based controls. Fluoridation was not found to be a risk factor for osteosarcoma in the study population. The trend in the data from this small sample study suggests the hypothesis that a protective effect may exist against the formation of osteosarcoma for individuals consuming fluoridated water.

A conceptual model of the market for dental services is described. The model is based on principles of demand and production theory and the applications of those principles to the dental industry. The model highlights the significance of relevant economic indicators which are discussed to create an awareness of and, when possible, explain the challenges awaiting dentistry in the decades to come. It is concluded that, while dental service expenditures per dentist are likely to increase, larger portions of the population may not be able to afford dental care if prices of dental services continue to increase faster than individual budgets.

The unmet and met need for prosthodontic services in the United States have been estimated and projected to the year 2000. Based on need-for-treatment estimates within the U.S. population collected by oral examination in 1971 to 1974, some 214.7 million hours of unmet need were estimated. By the year 2000, the projected need is expected to increase to approximately 264.7 million hours (if edentulism is assumed to be zero) or to approximately 293.8 million hours (if prevalence of prosthodontic need is assumed to remain stable). A concomitant rise in effective demand is also expected from 44.7 million hours in 1976 to 1977 to approximately 62.2 million hours in the year 2000. Thus, despite an assumption of declining edentulism, the unmet need for prosthodontic services will remain high.

A comprehensive analysis of the relationship between clinical observations in dental patients without symptoms and oral disease as detected by full-mouth and panoramic dental radiographs in a large population of patients has never been reported. Knowledge of these relationships is necessary in the design of a diagnostic decision process (clinical algorithm) that can predict which patients require dental radiographs for the diagnosis of dental caries or periodontal disease to be confirmed or refined. An accurate clinical algorithm could reduce the number of radiographs that are taken of certain routinely seen dental patients without symptoms, thus reducing unnecessary exposure x-radiation as well as potentially reducing health care costs for these patients. A sample of 602 adult men on whom a complete series of panoramic, posterior bitewing, and periapical dental radiographs and an independent oral examination were performed provided the opportunity to evaluate the relationship between clinically observed oral disease indicators and independent radiographic evidence of dental caries and periodontal disease. The analysis suggests that combinations of several clinical indicators can predict with some success which patients without symptoms will benefit most from oral radiographs. The presence of several carious lesions on oral examination was the best predictor of radiographic detection of dental caries. Clinical indicators that appear to predict radiographic evidence of periodontal disease are clinical measures of pocket depth, mobility, and the patient's denture status. An important finding is that because of the high prevalence of gingivitis and plaque, these indicators were not related to radiographic evidence of periodontal disease. Certain clinical indicators may be more or less important, depending on whether the clinician is attempting to diagnose dental caries alone, periodontal disease alone, or both disease simultaneously. The findings suggest that a thorough clinical examination can help the clinician recognize clinical indicators capable of identifying patients who will or will not exhibit additional radiographic findings on their dental radiographs.

In summary, between the 1960 to 1962 national health survey and the 1971 to 1974 national health survey, the mean periodontal index scores remained unchanged. However, the classification of adults into broad disease categories showed that those with no evidence of disease increased significantly. This improvement in the nation's experience with the periodontal diseases was restricted to those with gingivitis, and a concomitant improvement was observed in the nation's oral hygiene status; debris scores decreased substantially, whereas little change was observed in calculus scores. Hypotheses have been raised in this paper about the decline in the prevalence of gingivitis and its possible association with variables such as OHI-S scores, socioeconomic status, dental care utilization, cigarette smoking, fluorides, and antibiotics. Also noted between the two surveys was a slight decrease in the prevalence of periodontal pockets in persons younger than age 35, whereas in persons older than 35, there was either no change or a slight increase. During this same period, both total loss of teeth and number of missing teeth per person decreased for all ages. A hypothesis is proposed that links this slight increase in the more severe signs of periodontal disease in older adults to an increase in the number of teeth at risk to the disease. The modest change in the prevalence and severity of advanced periodontal disease may be an early sign of a trend that will become accentuated as a result of a distinct increase in the nation's older population coupled with the increased retention of the natural dentition. Thus, it would seem that a decline in edentulism and an increase in number of teeth per person may well contribute to circumstances that will lead to greater, not lesser, risk of advanced periodontal disease problems in the later decades of life. Although this hypothesis may or may not hold true for today's younger adults as they age, it seems to be the likely occurrence for the nation's older adults, at least for the next several decades. A third national survey, using the same indexes and more current periodontal disease measures, is needed to help to clarify the trends reported here.

The NHANES I and the Research Triangle institute data sets are used to quantify and compare the need and effective demand for periodontal care at the national level. How much more time could be spent with dental patients who need periodontal care? And why aren’t they coming for treatment? This sampling of national data provides surprising answers.

The national situation regarding prosthodontic services is being shaped by the following factors: 1.There is an increasing number of people in the 60-, 70-, and 80-year-old age group. 24 2.There is less dental caries, which has resulted in more teeth in the adult population. 3.There is less gingivitis, but it is unclear whether this factor is significant. 4.There is an ongoing debate about the continued prevalence and severity of periodontitis, but with more teeth and more older adults there appears to be a great potential for an increase in the total amount of advanced periodontal disease. 5.There is somewhat less total edentulism. 6.There is a substantial unmet need for complete dentures as well as fixed and removable partial dentures. In summary, the stage is set for an increased demand for prosthodontic services.