ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00347.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

This paper summarizes and evaluates epidemiologic evidence on adult dental conditions with a focus on older adults. Information is presented on coronal caries; root caries; loss of teeth, attrition, abrasion, and erosion; periodontal diseases; and oral cancer. The author concludes that the oral health status of the elderly in the United States is essentially unknown. There are no recent, representative population base studies of oral conditions in the elderly. Studies of prevalence or incidence of oral diseases typically include few elderly persons or describe a select group of elderly who are at high risk. Furthermore, it is not really known whether the incidence and prevalence of coronal caries or root caries is actually increasing or is part of a cohort effect. While oral cancers have been shown to increase with age, there is no information as to whether their incidence rates are increasing. While, clinically, there are indications that attrition, abrasion and erosion are characteristics that are more likely to be seen in older adults, there is no information about their distribution in the population. There is evidence that loss of teeth is decreasing but nothing is known about the patterning of that loss. As for periodontal diseases, much work is needed to identify various syndromes that may be distinguished by their distribution in the population as well as determining whether periodontitis is a condition responsible for a majority of tooth loss or just the majority of tooth loss in a small high risk group. In addition, some suggestions are presented for future directions of research in this area.

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00348.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Older persons utilize dental services at a significantly lower rate than they use other health services, and lower than the rates for younger age groups. This presentation will focus on utilization behavior within the framework of a person‐environment congruence model. Much of the previous research in this area has been concerned with the person component, specifically predisposing (demographic) and enabling (financial resources) variables. But these variables have rarely been found to predict a significant proportion of the variance in utilization behavior. More recent studies have examined perceived and objective need for dental care, and have found low perceived need among non‐utilizers. The author's own research on psychosocial factors in dental behaviors points to the role of attitudes, personality, and perceived oral health status in determining the older person's oral self‐care and utilization behaviors. Our research with elderly Caucasians and Pacific Asians suggests that reducing the traditional barriers to dental care delivery and educating older persons about oral health will not significantly improve their health care behaviors. Attitudinal barriers must first be overcome. Research on other psychological and environmental barriers to dental service utilization, and alternative methods of eliminating these barriers is needed. Areas of potentially valuable research are discussed. Only by moving from descriptive to more experimental studies such as these can we enhance the oral health behaviors of the elderly popul

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00349.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

The development of both myeloid cells and immunocytes from a common stem cell precursor, their differentiated pathways, functions and the factors which modulate them are briefly reviewed here. The age‐related decline (or lack of it) for the several cell lines is outlined, as well as the effect of this upon life processes and homeostasis. The results from two approaches to extending high levels of immune responses in aged mice are reviewe

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00350.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Although the skin of the elderly shows many clinically obvious changes such as wrinking, dryness and patchy pigmentation it is difficult to determine to what extent extrinsic factors are responsible. On the other hand the mucosa lining the mouth which is exposed to a different environment has been claimed to show many similar clinical changes. The literature describing age‐associated cellular changes is replete with conflicting reports. This is compounded by confusion of what constitutes “old”. There is no consensus on age‐associated changes of fundamental attributes such as epithelial thickness, rates of tissue turnover or metabolic activity. Studies being carried out by the author suggest that there are few structural changes which occur in all surface epithelia with age but glycolytic activity is significantly increased. Ultrastructurally, significant quantities of fine fibrillar material have been observed to be associated with the basement membrane of oral epithelium, blood vessels and nerve bundles in the cheek. It is concluded that structural and functional changes that occur in skin and mucosa with age have not yet been defined adequately and further research is necessary in th

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00351.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Recent studies on parotid gland flow rate and composition in healthy subjects do not support the conventional wisdom that there is a gradual deterioration in salivary gland function with aging. With gustatory stimulation a diminution in flow rate was observed only in post‐menopausal women taking medications. Studies of whole saliva and preliminary studies of submandibular saliva flow rate, however, suggest that these glands may exhibit functional changes not seen in the parotid. This would be consistent with histological findings. Reports to date on age effects on composition suggest modest selective changes in electrolytes (e.g. sodium) and only subtle changes in proteins (e.g. amylase isoenzymes). Clinical concerns (rampant caries, stomatitis, periodontal disease) arise largely because of the high number of elderly on medications or therapeutic interventions that affect salivary flow and the increase in incidence of diseases of the salivary gland (e.g. sialadeneitis, Sjogren's, sarcoidosis). Reduction in flow rate and alterations in composition diminish salivary protective mechanisms, i.e. antibacterial activity, lubrication and protection of soft tissues, and maintenance of hard tissue integrity. Recent research on structure of mucins, the nature of the salivary lipids and interactions among salivary proteins should stimulate a second generation of studies on both the effects of aging per se and aberrations resulting from disease. Stimulation of compromised function and development of more effective salivary substitutes are also important areas of researc

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00352.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Studies in the United States and other countries have shown that there is continued caries activity with advancing age. These studies, however, do not elaborate on the nature of the dental caries nor its anatomical location on the tooth. It has been assumed that dental caries occur on the coronal portion of retained teeth and that recurrent decay around existing restorations represents the major form of the disease. In addition to continued coronal caries activity in adults, the problem of carious lesions occurring on the exposed roots of teeth has been identified in a number of recent surveys. The exposure of the root surface to the oral cavity is a consequence of the apical migration of the periodontal attachment through periodontal disease and dental treatment which renders this part of the tooth at risk of the dental caries process. However, there are several distinct differences between coronal and root caries. The continued occurrence of coronal caries in adults and the projected increase m the prevalence of root caries suggests an expanded role for the restorative and preventive services for the older adult patient. Although the techniques relating to coronal caries are well‐established, those relating to root caries are just beginning to be explored and developed. Many of the principles, materials and philosophies which have proved to be effective for coronal caries are not equally efficacious when the tooth root is involved. This area represents a fertile field for research and development in the older adult patien

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00353.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

The proportion of elderly persons in the American population is increasing significantly, and the number of individuals losing all or some of their teeth is decreasing. Consequently, the number of teeth in the elderly at risk for developing periodontis is growing. The prevalence and severity of periodontitis apparently increase with increasing age. These facts have led to the widely held supposition, that periodontitis in elderly people is an ever‐increasing burden that society and the dental profession must face. A careful assessment of the data, especially the most recent, shows that this may in fact not be the case. Elderly people have a type of periodontitis that, at any given site, usually progresses infrequently and slowly. The enhanced prevalence and severity among older people may not result from an enhanced susceptibility, but rather, most likely reflect the accumulation of lesions over time. The most recent epidemiological studies indicate that the prevalence of gingivitis, the precursor to periodontitis, is decreasing significantly, especially in the younger segments of the population, and that this may translate into a markedly decreased prevalence of periodontics as these same individuals enter the older age groups. The types of therapy most needed in dealing with periodontitis in older people are not complex and the capacity to perform them does not require specialized periodontal training; it can, in fact, for the most part, be performed by auxillaries such as dental hygienists. Thus, the treatment burden on the dental profession will probably not be as great as in currently anticipated. The numerous gaps in our knowledge about periodontitis in the elderly include a poor understanding of its true prevalence and severity as well as its likelihood of occurrence and rate of progression. We have almost no knowledge about the flora at normal and periodontally diseased sites. Except for the immune system, we have but little knowledge about how the host defense mechanisms change during the aging process. Resolution of these questions would aid greatly in planning prevention and treatment programs and in improving therapeutic decision‐making in individual ca

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00354.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

The control of pain is an issue of major importance for older patients. As the proportion of elderly persons in society grows, these problems take on particular humanitarian and economic significance. Review of the literature indicates that the sensory mechanisms subserving pain in older persons are not unique, but painful pathologic states are more likely to occur in old age. Stereotypes of the older person have led to insufficient management and overmedication of this patient population. Moreover, the complex nature of chronic pain in the aged patient has not been appreciated by health care professionals. The literature points to an urgent need for more data that will shed light on the nature of pain problems in old age.

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00355.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Atypical facial pain describes a chronic pain state but does not imply an etiology. One‐hundred and two patients with atypical facial pain were evaluated. Patients were separated into two groups; 40 patients over age 60 and 62 patients under age 60. Comparisons between the two groups for sex, diagnostic classifications, location of symptoms, specific symptoms, and treatment results were performed. Medical/dental disorders (20%), psychiatric disorders (50%) and combinations of both (15%) were causes of atypical facial pain. Fifteen percent of patients had an indeterminate cause. Psychiatric treatment was effective in reducing psychopathology and pain when a psychiatric diagnosis was present. Burning of the oral mucosa as a specific symptom occurred more frequently in the elderly. No differences were noted between the two age groups in relation to sex, diagnostic classification, or treatment results. No particular psychiatric, medical or dental disorder predominated as a specific cause of atypical facial pai

ISSN:0734-0664    

DOI:10.1111/j.1741-2358.1984.tb00356.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY