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Denture Wearing during Sleep Doubles the Risk of Pneumonia in the Very Elderly

T. Iinuma,1,* Y. Arai,2,* Y. Abe,2 M. Takayama,3 M. Fukumoto,1 Y. Fukui,1 T. Iwase,4 T. Takebayashi,5 N. Hirose,2 N. Gionhaku,1 and K. Komiyama4
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ABSTRACT

Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health–related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence interval [CI], 1.11–4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25–4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06–4.34), history of stroke (HR, 2.46; 95% CI, 1.13–5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20–4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.

INTRODUCTION

Pneumonia is a major morbidity and mortality risk among the elderly. The 2010 Global Burden of Disease Study reported that lower respiratory tract infections, including pneumonia, are the fourth leading cause of death globally, and the second most frequent reason for years of life lost (). In Japan, pneumonia has ranked as the third leading cause of death since 2011, and the second leading cause of death among nonagenarians (Ministry of Health, Labour and Welfare 2012). Aspiration is an important pathogenic mechanism for pneumonia in the elderly, and poor oral health is increasingly recognized as a predisposing factor (). Indeed, randomized interventional trials demonstrated that professional oral care reduces the burden of pneumonia among the frail elderly in long-term care facilities (). It remains unknown, however, whether improving oral hygiene by altering behaviors could reduce the risk of pneumonia in community settings. With a rapid demographic shift toward the very elderly in the population and a concomitant increase in the global burden of poor oral condition (), the development of a motivational and self-manageable oral health promotion program for pneumonia prevention is a matter of public health priority. To identify behavioral risk factors, modification of which could provide tangible benefits for pneumonia prevention, we prospectively investigated associations between a constellation of oral health behaviors and pneumonia events in the community-living very elderly.

METHODS

Study Population

The Tokyo Oldest Old Survey on Total Health (TOOTH) is an ongoing prospective observational study organized by interdisciplinary experts, including geriatricians, dentists, psychologists, and epidemiologists. Details of its design, its recruitment, and the entire procedure have been described previously (). Between March 2008 and November 2009, we recruited a randomly selected sample of 542 inhabitants of Tokyo aged 85 years or older for medical and dental examination. Among them, 12 subjects were excluded because they lacked oral health assessment, and 6 were excluded because they did not have information on pneumonia incidence; thus, 524 subjects were included in the analysis (228 men and 296 women; mean ± SD age, 87.8 ± 2.2 years; range, 85–102 years).

Oral Health Assessment

The comprehensive oral health assessment comprised a face-to-face interview including oral health–related quality of life (QOL) (Geriatric Oral Health Assessment Index [GOHAI]), the ability to eat 15 items of food, a questionnaire regarding oral health behaviors, and dental examination by dentists (). To identify behavioral risk factors, we have developed a 13-item oral health–related and hygiene-related questionnaire (Appendix Table). The questionnaire includes 4 items on denture hygiene practices modified from the study by : frequency of denture wearing, frequency of denture cleaning, usage of denture cleanser, and denture wearing during sleep. These items were applied for 453 denture wearers only. Perceived swallowing difficulty was assessed with an item from GOHAI, “How often are you able to swallow comfortably?” After the interview, the dentist performed an oral examination to assess oral status, the presence of dental plaque, and gum inflammation according to the Standard of Dental Examination in School Health and Safety Act (). Denture plaque was assessed using a modification of the Ambjørnsen Denture Plaque Index (). The presence of plaque on dentures was scored from 0 to 3 using the criteria proposed by Ambjørnsen, in which 0 is equivalent to no visible plaque, 1 is equivalent to plaque visible only by scraping on the denture base with a blunt instrument, 2 is equivalent to a moderate accumulation of dental plaque, and 3 is equivalent to an abundance of plaque. For 268 consecutive participants examined between April 2009 and November 2009, microbiological samples from the dorsal surface of the tongue were scraped 5 times with a sterilized cotton swab. The specimens were immediately inoculated onto special medium (CHROMagar Candida) for detection of Candida, according to a modification of the procedure of .

Medical Assessment

At the same time as the dental examination, participants were interviewed and examined by trained geriatricians to assess medical conditions and medications, and to verify physical functional status (Barthel index). Cognitive function was evaluated according to the Mini-Mental State Examination (MMSE). Nonfasting blood samples were obtained at baseline, and plasma concentrations of albumin, creatinine, and C-reactive protein (CRP) were measured using standard assay procedures. Plasma levels of interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured in duplicate using commercially available ELISA (enzyme-linked immunosorbent assay) kits (Quantikine HS [Human IL-6] and Quantikine HS [Human TNF-α], respectively; R&D Systems, Minneapolis, MN). Interassay coefficients of variation of IL-6 and TNF-α were 9.43%, and 8.72%, respectively.

Outcomes

The outcome of interest was a serious pneumonia event, which was defined as first hospitalization for or death from pneumonia. Participants were followed up for all-cause and cause-specific mortality and hospitalization from cancers, cardiovascular disease, pneumonia, falls and fractures, and other causes by telephone contact or mail survey conducted every 12 months. At month 36, those who remained in the cohort were examined according to the same protocol as the baseline survey, and any hospitalizations during the observational period were confirmed.

Statistical Analysis

All analyses were performed using SPSS version 19.0 (SPSS, Chicago, IL). Baseline characteristics are expressed as means and standard deviations (SD) or as percentages. Continuous variables with a skewed distribution are described as medians (interquartile ranges [IQR]) and log-transformed for statistical analyses. We characterized denture wearing during sleep as either always (every night) or usually (5–6 nights/week). Differences in continuous variables at baseline were compared using the Mann–Whitney U test. The chi-square test was used to compare categorical variables. For longitudinal analysis, we plotted Kaplan–Meier survival curves according to the risk strata. A prognostically significant result was defined as log-rank P < 0.05. We then used the univariate and multivariate Cox proportional hazards model to assess the relative risk of incident pneumonia. First, biological and behavioral factors known to be associated with pneumonia mortality (age, sex, education, smoking status, low body mass index [<18.5], history of stroke, respiratory disease, diabetes mellitus, chronic kidney disease, use of angiotensin-converting enzyme inhibitors [ACEIs] and statins, and plasma levels of albumin, CRP, and IL-6) were calculated for hazard ratio (HR) in the univariate model; those with substantial associations (P < 0.1) were entered into the multivariate model. Because of the strong correlation between CRP and IL-6, they were entered separately in the model. Death from causes other than pneumonia was censored. In all analyses, P < 0.05 was taken to indicate statistical significance.

This research was approved by the Ethics Committees of Nihon University School of Dentistry (No. 2003-20, 2008) and Keio University School of Medicine (No. 20070047). The TOOTH is registered in the University Hospital Medical Information Network (UMIN)-Clinical Trial Registry (CTR) as UMIN-CTR (ID: UMIN000001842).

RESULTS

During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified, for an overall incidence of serious pneumonia of 3.1 per 100 per year. Seventy individuals died of other causes (cancer = 24; cardiovascular disease = 28; other causes = 15; and unknown causes = 3), 4 declined the follow-up survey, and 15 were censored at the time of last contact. The baseline characteristics of the participants are presented in Table 1. Those who developed pneumonia were more likely to have perceived swallowing difficulties, a habit of denture wearing during sleep, disability involving activities of daily living (ADL), cognitive impairment, lower body mass index (BMI), a history of respiratory disease and stroke, a lower level of albumin, and higher CRP and IL-6 levels. Neither remaining teeth, nor Eichner index score (), nor medication intake showed any association with pneumonia.

Table 1.

Baseline Characteristics of Participants Who Did or Did Not Develop Serious Pneumonia during 3-Year Follow-Up

Pneumonia

No Pneumonia

Characteristicsn = 48n = 476P*
Age, mean (SD)88.4 (2.5)87.8 (2.2)0.039**
Female, %45.857.60.128
Higher education, %21.317.00.426
Smoking, %44.438.70.523
BMI, mean (SD)20.6 (3.2)21.6 (3.2)0.122**
BMI <18.5, %25.517.30.166
ADL disability, %36.225.40.120
Cognitive impairment, %35.421.20.030
Oral health status
 Number of teeth, median (IQR)5 (0–12)7 (0–17)0.530**
 Edentulous, %25.030.70.510
 Eichner index, %a
  A8.39.8
  B14.623.90.288
  C77.166.3
 Swallowing difficulty, %21.312.00.105
 Gum inflammation, %b39.429.80.321
 Number of chewable foods, median (IQR)14 (13–15)15 (13–15)0.298**
 Dental office visit in the past year, %60.459.71.000
Denture hygiene practice (always or usually), %c
 Frequency of denture wearing97.793.80.498
 Frequency of denture cleaning72.768.90.731
 Usage of denture cleanser32.633.61.000
 Denture wearing during sleep58.139.30.022
Medical history, %
 Respiratory disease45.832.10.076
 Stroke25.011.30.011
 Diabetes20.818.50.698
 CAD6.310.70.457
 Hypertension60.459.51.000
 CKD45.849.70.651
Medications, %d
 ACEI user2.24.60.710
 ARB26.129.30.735
 Statins10.916.50.402
 PPI19.613.70.270
 Histamine H2 blockers13.012.81.000
Biochemical
 Albumin, g/dL (SD)e4.0 (0.3)4.1 (0.3)0.047**
 CRP, mg/dL, median (IQR)e0.15 (0.05–0.29)0.08 (0.04–0.17)0.011**
 Interleukin-6, pg/ml, median (IQR)f2.08 (1.45–3.11)1.67 (1.29–2.44)0.030**
 TNF-α, pg/ml, median (IQR)f2.48 (1.91–3.11)2.19 (1.88–2.79)0.116**

IQR, interquartile range; SD, standard deviation; BMI, body mass index; ADL, activities of daily living; CAD, coronary artery disease; CKD, chronic kidney disease; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; PPI, proton pump inhibitor; CRP, C-reactive protein; TNF-α, tumor necrosis factor-α.

a–fdata available for a508, b355, c453, d500, e520, and f511 people, respectively.
*Chi-square test, unless otherwise indicated.
**Mann–Whitney U test.
Because denture wearing during sleep was the only behavioral factor associated with pneumonia, we plotted Kaplan–Meier survival curves for cumulative incidence of pneumonia events according to this habit (Figure). Denture wearing during sleep was significantly associated with a higher risk of pneumonia (log rank P = 0.021).

In a multivariate Cox model, both swallowing difficulties and denture wearing during sleep were independently associated with an approximately 2.3-fold higher risk of incident pneumonia (for perceived swallowing difficulties, HR, 2.31; 95% CI, 1.11–4.82; and for denture wearing during sleep, HR, 2.38; 95% CI, 1.25–4.56), which were comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06–4.34), history of stroke (HR, 2.46; 95% CI, 1.13–5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20–4.23). To test the robustness of our results, we conducted a sensitivity analysis in which we excluded ADL disability from the multivariate model. We found a consistent association between denture wearing during sleep and incident pneumonia (HR, 2.35; 95% CI, 1.23–4.51). Another sensitivity analysis excluding those who died of causes other than pneumonia during the observation period (n = 70) demonstrated a solid association between denture wearing during sleep and pneumonia events in the multivariate model (HR, 2.37; 95% CI, 1.21–4.65; P = 0.012). None of the other denture hygiene practices or factors related to oral health status, including the number of remaining teeth, Eichner index, or use of denture cleansers, were significantly associated with incident pneumonia.

To gain mechanistic insight into the association between denture wearing during sleep and incident pneumonia, we examined baseline oral and denture status as well as systemic conditions in relation to denture habits (Table 3). Those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating IL-6 as compared with their counterparts. Thereafter, we incorporated each dental status item into the multivariate Cox model shown in Table 2, and we found that the associations between denture wearing during sleep and incident pneumonia were substantially attenuated and no longer statistically significant after further adjustment for gum inflammation or C. albicans (adjusted for gum inflammation, HR for overnight wearing, 1.45; 95% CI, 0.67–3.11; P = 0.344; and, adjusted for C. albicans, HR, 1.72; 95% CI, 0.66–4.46; P = 0.264), suggesting that the inflammatory and microbial burden of the oral cavity could provide a mechanistic link between denture wearing during sleep and incident pneumonia. The prevalence of ADL disability and coronary artery disease tended to be higher in nocturnal denture wearers than their counterparts; however, none of the systemic conditions had a significant impact on the relationship between denture wearing during sleep and incident pneumonia.

Table 2.

Hazard Risk from Univariate and Multivariate Cox Models for Incident Pneumonia

Univariate Model

Multivariate Model

CharacteristicsHR95% CIPHRa95% CIP
Age1.12(1.02–1.24)0.0241.09(0.97–1.21)0.146
Sex (female)0.66(0.37–1.16)0.146
Higher education0.92(0.50–1.67)0.773
Swallowing difficulty1.98(0.99–3.99)0.0552.31(1.11–4.82)0.025
Denture wearing during sleep2.01(1.10–3.69)0.0242.38(1.25–4.56)0.009
Smoking1.22(0.68–2.19)0.516
Cognitive impairment2.01(1.11–3.62)0.0212.15(1.06–4.34)0.034
ADL disability1.73(0.96–3.15)0.0700.76(0.36–1.60)0.467
BMI <18.51.59(0.83–3.06)0.166
Stroke2.47(1.29–4.75)0.0072.46(1.13–5.35)0.024
Respiratory disease1.68(0.95–3.00)0.0752.25(1.20–4.23)0.011
Diabetes1.14(0.57–2.30)0.706
ACEI user0.43(0.06–3.11)0.403
Statin user0.61(0.24–1.55)0.300
CKD0.87(0.49–1.53)0.625
ALB (1 SD increase)0.74(0.56–0.97)0.0271.05(0.75–1.46)0.790
CRP (1 SD increase)b1.29(1.08–1.53)0.0061.30(1.07–1.59)0.009
IL-6 (1 SD increase)b1.37(1.07–1.75)0.0131.20(0.92–1.58)0.186

HR, hazard ratio; CI, confidence interval; SD, standard deviation; ADL, activity of daily living; BMI, body mass index; ACEI, angiotensin-converting enzyme inhibitor; CKD, chronic kidney disease; ALB, albumin; CRP, C-reactive protein; IL-6, interleukin-6.

aAdjusted for age, swallowing difficulty, denture wearing during sleep, cognitive impairment, ADL disability, history of stroke, respiratory disease, and plasma levels of albumin, CRP, and IL-6. Variables with substantial association (P < 0.1) were entered into the multivariate model.
bCRP and IL-6 were entered separately in the multivariate model.

Table 3.

Oral Health Status and Behaviors According to Denture-Wearing Habit at Night

Denture Wearing During Sleep

Yes

No

Characteristicsn = 186n = 267P*
Age, mean (SD)88.1 (2.8)87.7 (1.9)0.702**
Female %58.657.70.923
Cognitive impairment, %25.821.30.308
ADL disability, %a31.924.80.109
Oral health status
 Number of teeth, median (IQR)4 (0–10)6 (0–14)0.067**
 Swallowing difficulty, %12.413.50.778
 Tongue plaque, %b42.232.50.046
 Gum inflammation, %c40.030.50.101
 Plaque adhesion, %c47.840.50.227
 Denture plaque, %d57.539.70.000
 Eichner index C, %e80.773.90.109
Candida carriers, %f
 Candida albicans57.843.40.025
 Candida tropicalis18.311.30.112
 Candida krusei22.019.50.646
 Total of 367.055.30.058
Denture hygiene practice (always or usually), %
 Dental office visit in the past year52.266.30.003
 Frequency of denture wearing98.992.90.002
 Frequency of denture cleaning63.473.80.022
 Usage of denture cleanser15.146.40.000
Medical history, %
 Respiratory disease31.732.60.919
 Stroke11.312.70.664
 Diabetes19.919.91.000
 CAD12.97.90.082
 Hypertension54.160.60.174
 CKD51.947.90.444
Biochemical
 Albumin, g/dL (SD)g4.1 (0.3)4.1 (0.3)0.776**
 CRP, mg/dL, median (IQR)g0.10 (0.04–0.19)0.09 (0.04–0.19)0.924**
 Interleukin-6, pg/ml, median (IQR)h1.81 (1.38–2.66)1.57 (1.25–2.27)0.017**

IQR, interquartile range; SD, standard deviation; ADL, activities of daily living; CAD, coronary artery disease; CKD, chronic kidney disease; CRP, C-reactive protein.

a–hData available for a 451, b 446, c 289, d 443, e 438, f 268, g 450, and h 442 people, respectively.
*Chi-square test, unless otherwise indicated.
**Mann–Whitney U test.

DISCUSSION

In this prospective study of the community-dwelling very elderly aged 85 years or older, we found that perceived swallowing difficulties and denture wearing during sleep conferred a 2.3-fold higher risk of serious pneumonia events, which is comparable with those attributable to major predisposing factors of aspiration pneumonia, such as history of stroke and respiratory disease, and cognitive impairment. Furthermore, wearers of dentures during sleep tend to have poor denture hygiene practices, fewer dental office visits, denture and tongue plaque, and oral candidiasis, suggesting that this habit could be a sensitive marker for identifying individuals at high risk of both poor oral health and aspiration pneumonia.

There have been few previous studies regarding the association between oral health status and pneumonia outcomes in the community setting. Awano et al. reported that the number of teeth with periodontal pockets was associated with higher mortality from pneumonia in the very elderly aged 80 years or older (). In a cohort of community-dwelling and well-functioning seniors, Jutbini-Mehta et al. identified mobility limitation and oral plaque burden as modifiable risk factors for pneumonia requiring hospitalization (). Our results corroborated these studies by demonstrating an epidemiological link between denture wearing during sleep and serious pneumonia, which suggests potential implications of oral hygiene programs for the prevention of community-acquired pneumonia in the very elderly.

Elucidating the biological mechanisms by which denture wearing during sleep raises the risk of serious pneumonia is likely to provide rational information to design effective and convincing oral health programs for the very elderly, who have an increased need for removable prostheses and show loss of immune competence. First, even in a healthy older adult, aspiration of unnoticed oropharyngeal and periodontal secretions occurs during sleep, and a high incidence of silent aspiration is strongly related to pneumonia among the elderly (), particularly those with dementia or cerebrovascular disease. Denture wearing during sleep was reported to be associated with poor denture hygiene, oral candidiasis (), and denture stomatitis (; ; ; ), all of which may function as reservoirs of potentially infectious pathogens (). Our findings that denture wearers during sleep had significantly higher rates of denture and tongue plaque and oral candidiasis provide additional evidence for this suggestion. The secretion and function of saliva might have substantial influences on the relationship between denture wearing during sleep and Candida infection. Previous studies speculated that nocturnal denture wearing decreases the protective effects of saliva against Candida spp. (; ). Although Candida spp. infrequently cause pneumonia, they are an important risk factor for denture stomatitis (), which is characterized as inflammation and erythema of the oral mucosa and its predisposal to bacterial pathogens. Therefore, the protective effect of saliva is an important factor of denture stomatitis as well as aspiration pneumonia, and it would be wise to look into patients’ nocturnal denture-wearing habits and relations with oral immunity, or their salivary defense proteins such as immunoglobulin A. Second, denture wearing during sleep may be an indicator of overall poor oral hygiene practices. In the present study, denture wearers during sleep were characterized by lower frequencies of dental visits and denture cleaning, and extremely limited usage of denture cleansers compared to their counterparts. In this scenario, it remains unclear whether the physical removal of dentures during sleep is sufficiently efficient to reduce the risk of pneumonia, or if assiduous hygiene practices have preventive effects. Because of the observational nature of this study, we did not address this issue. Recently, a randomized clinical trial of institutionalized subjects demonstrated that overnight storage of dentures with alkaline peroxide-based tablets significantly decreased denture biofilm and the amount of C. albicans to a greater extent than dry or water preservation (). There is a great deal of evidence supporting the effect of biofilm removal using a denture cleanser (); however, few studies have reported its practical usage, such as the dipping time (). Future prospective and interventional studies are warranted to examine whether appropriate use of cleansers or other methods (e.g., microwave cleaning) in combination with overnight denture removal could further reduce the risk of pneumonia in the elderly.

Based on evidence supporting a mechanistic link between continuous denture wearing and Candida-related stomatitis, guidelines and dental professionals have recommended the overnight removal of dentures for many years. Nevertheless, a surprisingly high percentage of senior denture users do not remove their dentures during the night, for example 41.5% of patients at a university clinic in Brazil (), 55.2% of complete denture wearers aged 60 years or older in Turkey (), and 24.2% of edentulous elderly in a longitudinal cohort study in Canada (). Therefore, to change denture wearers’ behavior, exploration of contributing factors to the disparity between knowledge and behavior may be an effective approach. From a psychosocial viewpoint, the reasons for denture wearing during sleep may be multifactorial and vary according to age, sex, and cultural background. A study in Brazil suggested that the presence of a partner could be a reason for denture wearing during sleep (); however, this may not have been the case for our participants, because those who lived alone exhibited a comparably high percentage of overnight denture wearing. Another reason the elderly do not remove their dentures at night is that the remaining teeth and denture precision attachment might hit the contralateral residual ridge in participants without opposing tooth occlusion (e.g., Eichner classifications C1 and C2). Such elders might wear dentures to avoid sharp pain. In fact, we found that the incidence of Eichner classification C tended to be higher in nocturnal denture wearers than in nonwearers (wearers, 80.7%; nonwearers, 73.9%; P = 0.109), which partially supports this notion.

In contrast to previous studies, neither educational achievement nor economic status was associated with denture-wearing habits in the present study. A possible alternative is fear of denture loss in the case of an unexpected event. During the Great Hanshin-Awaji earthquake in 1995, denture loss was a serious problem encountered by many elderly disaster victims (). In an earthquake-prone country such as Japan, innovation of emergency interim denture technology () and dissemination of survival manuals with appropriate information on denture storage could be effective approaches to encourage the removal of dentures during sleep at night.

Our study had several limitations. First, pneumonia in the elderly can occasionally be underdiagnosed due to its atypical presentation. In this study, we relied on death or acute hospitalization from pneumonia only, which may have resulted in underestimation of the incidence of pneumonia. We expect this effect to be approximately similar across oral health status, however, and not to affect comparisons between denture-wearing categories. Second, our sample size was relatively small, and it was limited to seniors living in the Tokyo Metropolitan Area. Dental resources and delivery systems vary among countries and localities. Therefore, our findings must be validated in a larger scale, separate cohort study. Third, our sample solely comprised very old individuals, who more frequently present with physical and cognitive disabilities and have a higher rate of mortality from pneumonia than younger elders. Therefore, it might be difficult to generalize our findings to younger populations. In addition, we did not examine denture stomatitis precisely using measures such as the Newton scale in this study. A further study is warranted because the state of denture stomatitis could represent a mechanistic link between denture-wearing habits and the risk of pneumonia.

In conclusion, the present study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, a potentially life-threatening condition in the very elderly. These results suggest that simple denture care habits could reduce the risk of pneumonia in the community. To meet the widespread need for dental prostheses among the very elderly in both developed and developing countries, evidence-based guidelines () as well as oral health promotion programs with appropriate denture care should be urgently disseminated to dental professionals, primary care providers, and community services.

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AUTHOR CONTRIBUTIONS

T. Iinuma, Y. Arai, contributed to conception, design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript; Y. Abe, M. Takayama, M. Fukumoto, Y. Fukui, contributed to data acquisition and analysis, critically revised the manuscript; T. Iwase, contributed to data analysis, critically revised the manuscript; T. Takebayashi, N. Gionhaku, K. Komiyama, contributed to conception and data interpretation, critically revised the manuscript; N. Hirose, contributed to design, data acquisition, and interpretation, critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.

–

SUPPLEMENTARY MATERIAL

Supplementary material:Supplementary material:

ACKNOWLEDGMENTS

We thank the participants for their time and personal information and Ms. Miho Shimura for her kind assistance. In addition to the authors, the following contributed to data acquisition as TOOTH investigators: Ken Yamamura, MD, PhD; Yoshinori Ebihara, MD, PhD; Kenichiro Shimizu, MD, PhD; Susumu Nakazawa, MD; Kensuke Nishio, DDS, PhD; Kentaro Urata, DDS; Mitsuru Maruno, DDS; Reio Ito, DDS; and Midori Takayama, PhD.

FOOTNOTES

A supplemental appendix to this article is published electronically only at http://jdr.sagepub.com/supplemental.

This study was funded by grants from the Grants-in-Aid for Scientific Research (B) (No. 21390245) and (C) (Nos. 20590706, 21590775, 24590898, 22593247, 26463194) from Japan Society for the Promotion of Science, by a grant from the Sato from Nihon University School of Dentistry, by a grant from Japan Health Foundation for the Prevention of Chronic Disease and the Improvement of QOL of Patients, by a grant from the Foundation for Total Health Promotion, by The Univers Foundation, and by the Chiyoda Mutual Life Foundation.

The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

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  • Duyck J, Vandamme K, Muller P, Teughels W. 2013. Overnight storage of removable dentures in alkaline peroxide-based tablets affects biofilm mass and composition. J Dent. 41:1281–1289. [PubMed] []
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  • Emami E, Salah MH, Rompre P, Huynh N, Beauchamp A, Feine JS. 2013. The nocturnal use of complete dentures and sleep stability in edentulous elders. J Dent. 41:703–709. [PubMed] []
  • Evren BA, Uludamar A, Iseri U, Ozkan YK. 2011. The association between socioeconomic status, oral hygiene practice, denture stomatitis and oral status in elderly people living different residential homes. Arch Gerontol Geriatr. 53:252–257. [PubMed] []
  • Felton D, Cooper L, Duqum I, Minsley G, Guckes A, Haug S, et al. 2011. Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists. J Prosthodont. 20(Suppl 1):S1–S12. [PubMed] []
  • Fenlon MR, Sherriff M, Walter JD. 1998. Factors associated with the presence of denture related stomatitis in complete denture wearers: a preliminary investigation. Eur J Prosthodont Restor Dent. 6:145–147. [PubMed] []
  • Hyogo Dental Association. 1996. A report and proposal from the Great Hanshin Awaji Earthquake. Great Hanshin-Awaji Earthquake Disaster Material Collection; 33:41–48 [article in Japanese]. []
  • Iinuma T, Arai Y, Fukumoto M, Takayama M, Abe Y, Asakura K, et al. 2012. Maximum occlusal force and physical performance in the oldest old: the Tokyo oldest old survey on total health. J Am Geriatr Soc. 60:68–76. [PubMed] []
  • Ikebe K, Morii K, Matsuda K, Hata K, Nokubi T. 2006. Association of candidal activity with denture use and salivary flow in symptom-free adults over 60 years. J Oral Rehabil. 33:36–42. [PubMed] []
  • Janssens JP, Krause KH. 2004. Pneumonia in the very old. Lancet Infect Dis. 4:112–124. [PubMed] []
  • Japanese School Dental Association. 2007. Activity guidelines of the school dentists (revised edition. Tokyo, Japan: Issei Print Co., pp. 43–55 [Document in Japanese]. []
  • Jose A, Coco BJ, Milligan S, Young B, Lappin DF, Bagg J, et al. 2010. Reducing the incidence of denture stomatitis: Are denture cleansers sufficient? J Prosthodont. 19:252–257. [PubMed] []
  • Juthani-Mehta M, De Rekeneire N, Allore H, Chen S, O’Leary JR, Bauer DC, et al. 2013. Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study. J Am Geriatr Soc. 61:1111–1118. [PMC free article] [PubMed] []
  • Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. 1994. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med. 150:251–253. [PubMed] []
  • Kurozumi A, Akamatsu Y, Shiraki A. 2010. Emergency interim denture construction method at disaster area. Ann Jpn Prosthodont Soc. 2:260–266. []
  • Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. 2012. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 380:2095–2128. [PubMed] []
  • Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, et al. 2013. Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res. 92:592–597. [PMC free article] [PubMed] []
  • Pires FR, Santos EB, Bonan PR, De Almeida OP, Lopes MA. 2002. Denture stomatitis and salivary Candida in Brazilian edentulous patients. J Oral Rehabil. 29:1115–1119. [PubMed] []
  • Shulman JD, Rivera-Hidalgo F, Beach MM. 2005. Risk factors associated with denture stomatitis in the United States. J Oral Pathol Med. 34:340–346. [PubMed] []
  • Silva-lovato CH, De Wever B, Adriaens E, Paranhos HFO, Watanabe E, Pisani MX, et al. 2010. Clinical and antimicrobial efficacy of NitrAdineTM-based disinfecting cleaning tablets in complete denture wearers. J Appl Oral Sci. 18:560–565. [PMC free article] [PubMed] []
  • Sumi Y, Kagami H, Ohtsuka Y, Kakinoki Y, Haruguchi Y, Miyamoto H. 2003. High correlation between the bacterial species in denture plaque and pharyngeal microflora. Gerodontology. 20:84–87. [PubMed] []
  • Takamiya AS, Monteiro DR, Barao VA, Pero AC, Compagnoni MA, Barbosa DB. 2011. Complete denture hygiene and nocturnal wearing habits among patients attending the prosthodontic department in a dental university in Brazil. Gerodontology. 28:91–96. [PubMed] []
  • Vigild M. 1987. Oral mucosal lesions among institutionalized elderly in Denmark. Community Dent Oral Epidemiol. 15:309–313. [PubMed] []
  • Wang J, Ohshima T, Yasunari U, Namikoshi S, Yoshihara A, Miyazaki H, et al. 2006. The carriage of Candida species on the dorsal surface of the tongue: the correlation with the dental, periodontal and prosthetic status in elderly subjects. Gerodontology. 23:157–163. [PubMed] []

Articles from Journal of Dental Research are provided here courtesy of International and American Associations for Dental Research

Dog Steals Family’s Dentures And Makes The World Smile

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Milo the very good Jackapoo provided comic relief after learning to open drawers.

The world could use a laugh right now ― and Milo the denture-stealing Jack Russell-poodle mix is happy to oblige.

The pup pilfered the false teeth from his owner’s mother this month in Llandudno, Wales, the New York Post reported. And by the sound of the video above, he supplied plenty of laughs for his human, Stacie Owen.

She said that Milo has learned to open drawers and emerged with this grin-inducing treasure.

“I wondered why he went quiet and found him in the bedroom with my mum’s old dentures,” she said, per the Daily Mail. “He likes to hold things in his mouth, he feels very proud when he has something. Whenever we go on a walk he will always bring something home.”

Hey, Milo, did you remember the Efferdent?

Watch Milo here

Article from Huffpost.com

 

 

COVID-19: Critical Link With Dentures & Oral Appliance Hygiene

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COVID-19

Why Oral Appliance Hygiene Is More Important Than Ever For High-Risk Populations

Because of the Covid-19 pandemic, personal hygiene is more important than ever. But did you know that there is a critical connection between oral appliance hygiene and the risk of developing severe symptoms from Covid-19? Just like washing hands and using surface disinfectants is necessary to help prevent exposure to the novel coronavirus, it is essential to disinfect oral appliances and maintain a strong daily oral hygiene routine to help protect High-Risk populations from pathogens which can contribute to the severe respiratory infections related to Covid-19.

What is Covid-19, and how does it develop into Acute Respiratory Distress?
From the current information issued by the CDC and WHO on Covid-19- symptoms can range from mild to severe. The most serious cases of the virus are characterized by severe pneumonia infections in the lungs and acute respiratory illness. The COVID-19 virus weakens the immune system and damages the cells in the respiratory tract. This can result in Pneumonia and Acute Respiratory Distress Syndrome (ARDS). ( https://www.cdc.gov/pneumonia/causes.html )

Why are people with Dentures and Oral Appliances at a higher risk of experiencing severe symptoms related to Covid-19?
The primary pathogen responsible for Pneumonia is streptococcus, which already exists in the natural human microbiome. Streptococcus and other dangerous pathogens can colonize on oral appliances and dental prosthetics. This can then spread to infect the entire respiratory system This is why denture-wearers suffer from a higher rate of Pneumonia, Respiratory Issues, Thrush, and a range of other illnesses. Additionally, clinical studies have found that sleeping with oral appliances can significantly increase the risk of developing Pneumonia. Patients with orthodontic appliances, airway/sleep devices, and dentures are more likely to experience severe cases of Covid-19.

The higher risk of developing Pneumonia, along with other factors like age and existing health conditions, means that denture wearers and people with oral appliances need to take extra precautions to disinfect these appliances to help reduce the risk of developing Acute Respiratory Distress Syndrome related to Covid-19. Otherwise, an infected appliance is likely to exacerbate the most severe symptoms of Covid-19 exposure.

What can Denture and Oral Appliance Wearers do to reduce risk of developing Acute Respiratory Distress Syndrome from Covid-19?
While it is very important that everyone takes action to minimize their risk of exposure to Covid-19, including thorough and frequent hand-washing, use of surface disinfectants and hand-sanitizer, it is also essential that people in High-Risk demographics work to minimize the potential of developing severe symptoms if exposed.

The prevalence of Streptococcus, Candida Albicans, Staphylococcus & E. Coli on oral appliances can lead to rapid deterioration of patients exposed to the novel coronavirus, as the pathogens take advantage of the weakened respiratory system to spread into major infections.

Dr. Berland’s Cleanadent Liquid Crystal Soak Cleanser is the ONLY denture/oral appliance cleanser that has been proven to kill 99.99% of these disease-causing bacteria and fungi which are responsible for Pneumonia, Thrush and many additional health issues. Other soak cleansers, including tablets and powders, only claim to kill “odor-causing bacteria” and have no effect on the pathogens responsible for Pneumonia.

This is why dental professionals highly recommend a strong oral hygiene routine which includes a daily 5-20 minute soak with Dr. Berland’s Cleanadent Liquid Crystals as part of an effective system which combines preventing exposure to Covid-19 and reducing the risk pathogens on the oral appliance contributing to the development of Acute Respiratory Distress Syndrome if exposed to the virus.

Cleanadent Liduid

Does the Cleanadent Liquid Crystal Soak Cleanser kill the Covid-19 virus?
While the Covid-19 virus is still too new to have been tested in a clinical study with Dr. Berland’s Cleanadent Liquid Crystals, the cleanser has been proven to kill 99.99% of the bacterial and fungal pathogens responsible for respiratory infections that are a major component of severe Covid-19 cases.

Patients in High-Risk demographics should take effective precautions that combine limiting exposure to the virus and disinfecting oral appliances to minimize the risk of existing infections exacerbating the severity of Covid-19 if exposed.

Do I still need to disinfect my appliance even if I don’t test positive for Covid-19?
Even before the novel coronavirus pandemic, Pneumonia was one of the leading causes of death for seniors globally. As the pandemic continues to grow in scale, healthcare systems are in danger of becoming overstretched to meet needs of patients. Even if a patient tests negative for the novel coronavirus, the current shortage of hospital space, healthcare workers, ventilators and other equipment, makes this a very inopportune time to be hospitalized with Pneumonia or other health issues.

Additionally, hospitalization can put those patients at a greater risk of exposure to Covid-19, even if there for unrelated treatments. Due to the current healthcare crisis, it is crucial that everyone takes precautionary measures to help avoid any health issues from developing at this time while we try to flatten the curve of new infections.

” Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. “~ International & American Associations for Dental Research ( https://www.sciencedaily.com/releases/2014/10/141007144514.htm )

Dr. B Dental Solutions is committed to helping limit the spread of Covid-19 and sharing the tools to protect at-risk populations from severe cases.
We’re offering a major 30% discount on our Cleanadent Liquid Crystals Soak Cleanser and Cleanadent Denture & Gum Wipes online to help make the products more affordable to those who need it. Just visit www.DrBDentalSolutions.com and use Promo Code: CLN30 at checkout and have the products delivered right to your door! Additional discounts are available when purchasing 2 units or more at a time and we offer a heavily subsidized flat-rate shipping cost, regardless of order size, to make delivery easy and affordable, so you can save even more when you purchase several items at a time!

Dr. B Dental Solutions

Dental Professional Guide to Improve Patient Value

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Dr. B Dental Solutions
Easily Improve Your Patient’s Experience by Recommending the Best Home Care System!

Great for Office Retail & Patient Give-Aways FREE Samples & Patient Materials Custom Online Coupons For Your Patients

ADA

THE MOST EFFECTIVE APPLIANCE CARE SYSTEM
Help Prevent Oral Infections, Dry Mouth & Sore Spots

Make Home-Care A Part Of Your
Office Protocol & See The Results!

Cleanadent

Developed by a Dentist, Recommended by Dentists

Why It’s Essential To Teach Patients Oral Appliance Hygiene

Without Proper Home Care, Oral Appliance Patients Are At Risk Of Serious Health Issues!

Almost All Oral Appliances Will Get Infected Over Time!

• Candida Albicans, Streptococcus, Staphylococcus, Actinomyces & E. Coli –These Dangerous Bacteria & Fungi Already Exist in Gut Microbiome
•Infections occur because pathogens colonize & thrive on oral appliances – Leading to Thrush, Cheilitis, Pneumonia, Respiratory and Digestive Issues

The Risk Is Particularly Significant For Ortho, Sleep & Airway Devices!

• Sleeping with an oral appliance Dramatically Increases The Risk Of Infection

• Breathing through an infected appliance can result in Pathogens Spreading To The Respiratory System And Sinuses

Common DIY Cleaning Methods Can Actually Harm Appliances!

• A Lot Of Misinformation Online – Patients Need To Learn From You!

• Toothpaste, Alcohol, Vinegar, Hydrogen Peroxide, Baking Soda & Mouthwash– These Are Too Abrasive & Will Damage Appliances
• Warn Patients About The Dangers Of Improper Care & Start Them Off Right!

Ideal Protocol For Each Case:

Explain Risks of Improper Care
• Give Cleaning Instructions
• Recommend The Most Effective
Products & Show How They Work
• Give Samples & Info Materials

When Your Team Does This –
It Shows You Care & Patients Love It!

Ideal protocol for each case

Denture Wearers Have Been Suffering!

Millions of Denture-Wearers suffer from chronic infections.
Many don’t even know it – they just feel worse over time!

Denture-Wearers Are Particularly
Susceptible To Infections
Majority of Denture-Wearers Suffer From LowGrade, Chronic Infections. Risk Increases Due To
Factors Such As Age, Medication, Habits, Hygiene
• Can Eventually Lead To Serious Health Issues
– Respiratory & Gastrointestinal Systems Are
Highly Impacted. May Even Result In Death.

Dry mouth (Xerostomia) Is
Most Cited Denture Problem

• Foreign Object Inhibits Saliva Production –
Other Brands Dry Out The Mouth Further!
• Leads To Irritations, Sores & Infection.
• Natural Saliva Is Essential For Good Oral Health
– Eating, Moisturizing & Regulating Oral Flora
– Enzymes & Chemistry Are Not Replicated In
Artificial Saliva Substitutes

Denture Adhesives Don’t
Stick Anymore

In 2010 FDA Banned Zinc from Denture
Adhesives after discovering it causes nerve
damage & gastro-intestinal problems.

• Major Brands Did NOT Reformulate –
Denture Adhesive Is Now Less Retentive
• Denture-wearers Have Noticed!

No New Denture Products Or
Innovations In Over 40 Years!
• The Same 3 Major Brands For Decades
• Prevalent & Significant Issues Like Infections,
Dry Mouth & Discomfort Left Unaddressed
• The Main Brands Are NOT ADA-ACCEPTED!
• Big Question For Patients: How Do You Clean
Fixed Full Arch Implant-Bridges?

Dr. B Solutions

The Benefits & Differentiators of Dr. B Dental Solutions

Modern Science Combined with Time-Tested Natural Remedies

Adhesadent

Adhesadent
• Revolutionary Formula Helps Treat and
Prevent Dry Mouth
• Soothes & Moisturizes Mouth with
Vitamins A, D & E and Aloe Vera
• New Copolymer Provides a Powerful,
Long-Lasting Hold that is Easy to Clean
through Van der Waal’s Force
• Zinc Free, No Artificial Colors or
Flavors
• The Only Denture Adhesive
Developed by a Dentist & Accepted
By The ADA!

Cleanadent Paste

Cleanadent Paste
DENTURE & GUM CLEANSING PASTE:
•The Only Toothpaste Designed To Safely
Clean Prosthetic Teeth and Gums

•Regular Toothpaste Damages Dentures & Bridges
•Ideal for Fixed & Removable Implant Bridges

•Cleans, Soothes & Moisturizes the Mouth with
Vitamins A, D & E, Aloe Vera, Coconut Oil and
Tea Tree Oil
•Excellent at Removing Adhesive from Dentures
•No Artificial Colors, Flavors or Harsh Chemicals
•The Only Denture Toothpaste Developed By A
Dentist & Accepted By The ADA

Cleanadent Wipes

Cleanadent Wipes
DENTURE & GUM CLEANSING WIPES
• The Only Moist Wipes Designed To
Safely Clean Both Prosthetic Teeth &
Gums
• Ideal for On-The-Go Hygiene, Dining
Out & Seniors with Limited Dexterity
• Cleans, Soothes & Moisturizes the Mouth
with Vitamins A, D & E, Aloe Vera,
Coconut Oil and Tea Tree Oil
• Excellent at Removing Denture Adhesive
• No Artificial Colors, Flavors or Harsh
Chemicals
• The Only Wipes Accepted By The ADA

Cleanadent Liquid Crystals

Cleanadent Liquid Crystals
Disinfecting Oral Appliance Soak Cleanser
•Instantly Kills Candida, Strep, Staph, E. Coli &
Other Highly Prevalent & Dangerous Pathogens
•Helps Prevent Oral Infections like Oral
Thrush, Stomatitis, Cheilitis & Pneumonia
•Other Cleansers Only Claim To Kill “OdorCausing” Bacteria – Don’t Stop Infections
•Completely Eliminates Odors, Tough Stains,
Plaque & Debris with No Over Night Soak
•Naturally Derived – No Harsh Chemicals like
Alcohol, Bleach, Chlorine or Peroxide

Dr. B Sonic Cleaner

Dr. B Sonic Cleaner
Ultrasonic Wave Vibrating Bath
• Mechanically Cleans By Generating High
Frequency Ultrasonic Waves
• Loosens & Removes Deposits of Plaque,
Debris, Calcium & Pathogenic Biofilm
• Portable (Batteries Included), Affordable &
Easy To Use!
• Patients LOVE IT – Call It The Denture Jacuzzi!
• Great for Convenient Appliance Storage

RetailDr. B Denture & Gum Brush

Dr. B Denture & Gum Brush
Denture and Gum Brush
(Coming Soon – May 2020)
•Ergonomic Grip Handle Perfect for
Seniors and Individuals with Limited
Dexterity
•Unique Multi-Layered Ridge Bristles
Design To Follow Denture Contours
• Dual Sided Head for Superior Cleaning
of Grooves & Hard to Reach Spaces
•Extra Soft Bristles Safe for Cleaning
Prosthetics and Gums
Retail: $12.95
Wholesale: $6.25
Retail: $6.95 *
Wholesale: $3.45
Retail: $15.95
Wholesale: $7.95
*Indicative Pricing
The Benefits & Differentiators of Dr. B Dental Solutions
Modern Science Combined with Time-Tested Natural Remedies
•Available in 3 Fun Colors!

Dr. B Dental Solutions_Page_06

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Educate Patients on Hygiene Risks of Oral Appliances

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It’s estimated that up to 80% of removable oral appliances are infected with Candida Albicans, a yeast infection of the mouth. The risk of infection increases with use over time.

Millions of people are infected with pathogens like Candida and Streptococcus in the U.S. alone. Most of these people have been suffering from low-grade infections for so long that they don’t even know they are sick. The symptoms—cheilitis, stomatitis, and loss of taste—become normal.

Denture-wearers are particularly at risk for developing long-term oral infections. Factors like age, medication, and illness can make people significantly more prone to Candida and Strep. Many elderly people continue to use their dentures well beyond the recommended replacement time and do not know how to properly clean them. Medications can exacerbate the issue by disrupting the normal oral flora and/or causing dry mouth. Unfortunately, these infections are often left untreated because when denture-wearers have a problem, they go to a drugstore, not a dentist.

That’s why it is important for dental professionals to educate patients about the hygiene risks associated with oral appliances. Even though the number of people with prosthetic teeth and removable dental devices keeps growing, there is still not much information out there for people to take proper care of their appliances. I’ve seen this personally—I started my career as a denture technician before practicing cosmetic dentistry for over 35 years.

Many patients don’t know that toothpaste is too abrasive for removable oral appliances. Dentures, mouth guards, snoring devices, and retainers are softer than teeth. Regular toothpaste and a toothbrush will damage these appliances and actually make them less clean.

Though the scratches are microscopic, there will be a visible difference in shine, finish, and color and the appliance will become the perfect breeding ground for bacteria.

Dental professionals are aware of the prevalence of Candida and Streptococci on oral appliances, but there isn’t an easy way to prevent these infections at home on a daily basis. Major brand denture cleansers can only claim to kill “odor-causing bacteria,” and many require an overnight soak. Unfortunately, these cleansers have no effect on virulent pathogens like Streptococci and Candida.

I developed several over-the-counter products for maintaining oral appliances. The Cleanadent line includes soaking crystals used in a sonic cleaning unit to kill pathogens like Candida and Strep, remove heavy stains in 20 minutes, and to clean deeply to help prevent colonization.

With information becoming ever more accessible and removable oral appliances on the upswing, the dental community should do more to educate patients about maintaining their appliances, understanding the risks facing their oral health, and looking for the right products when developing an oral hygiene routine. I always gave a few packets of a cleanser and a sonic cleaner with every removable. And patients appreciated it!

Lorin Berland, DDS, is a prominently published author on clinical dentistry and has been featured as a thought leader for the dental field in national TV programs and publications, such as 20/20, Time, Town & Country, and GQ. In 2008, Dr. Berland was recognized by the AACD for “Outstanding Contributions to the Art and Science of Cosmetic Dentistry.” Dr. Berland is working on an education campaign on oral hygiene for removable appliances. He has developed a line of products for treating common conditions like Candida and dry mouth. Details are available at DrBDentalSolutions.com.

Dr. B Dental Solutions Cover All Denture Needs

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Almost 40 million Americans wear dentures, and their numbers continue to grow every day. But dentures are not always comfortable, and to address common complaints about these vital health products for consumers, Dr. Lorin Berland developed Dr. B Dental Solutions. These products evolved from listening to the needs of real patients, seeking to help denture wearers live happier and healthier lives.

Adhesadent Denture Adhesive

The first of its kind, this moisturizing denture adhesive has a new copolymer that doesn’t need zinc. Excess zinc can result in neuropathy, dementia, and senility, so in 2008, the Food & Drug Administration (FDA) mandated denture adhesives remove or reduce the amount of zinc in their formulas. These adhesives are safer, but they don’t hold as well. Adhesadent works independent of zinc to provide much better retention, while vitamins A, D, E, and aloe vera help moisturize the mouth for greater comfort. And because you use less, it’s economical too.

Ultra Mild Cleanadent Toothpaste & Wipes 

Denture wearers are always looking for better ways to clean their dentures and mouths.

Dr. B created Ultra Mild Cleanadent Toothpaste & Wipes for on-the-go hygiene.  Not only do they clean, but they moisturize and refresh with vitamins A, D, E, and aloe vera, coconut oil and tea tree Oil. And everyone loves the revolutionary new Denture & Mouth Toothbrush.

Liquid Crystals 

Many people have removable dental appliances, such as nightguards, aligners, retainers, and airway devices. Unfortunately, over time, these appliances can become infected with dangerous bacteria and fungi. Denture wearers are far more likely to suffer from pneumonia, and that number can escalate if they sleep in their dentures as well.

Liquid Crystals is the only soak cleanser that kills staph, strep, candida, E. coli, and more, which are the major causes of thrush, pneumonia, and respiratory and digestive disorders. The Liquid Crystals are ideal for retainers, aligners, and especially snore and apnea dental devices.

Liquid Crystals, especially when used with our Sonic Cleaner, is the most effective way to clean and disinfect dentures and dental appliances.

The fascinating history of dentures

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A historical quick bite: 2,700 years of history in 400 words.

For most people, the history of dentures probably starts with the schoolyard tale of George Washington and his wooden teeth. But dental professionals — especially lab techs and denturists — know that there’s much more to the story.

Old dentures

Dentures trace their roots back to around 700 BC when the Etruscans of ancient, northern Italy made the first false teeth out of human or animal teeth. These were not long-lasting appliances, however. They quickly deteriorated, but were easy enough to produce and remained the standard until the 1700s. While Etruscan dentures were made with human or animal teeth, in the 1700s materials improved with the introduction of walrus, elephant and hippopotamus ivory.

Processes and materials once again changed in the 1770s. French dentists were displeased with ivory and turned to one piece, “incorruptable” dentures, made out of porcelain. To give the appearance of natural teeth, each tooth was individually hand-painted. Unfortunately, those dentures were brittle, lacked esthetics, and shrink when they were fired.

Back to George Washington and his famous dentures: That schoolyard fable of our first president’s teeth being made out of wood is far from the truth. The fact of the matter is that President Washington’s dentures were the most quality, top-of-the-line prosthodontics available in the mid-1700s. His dentures were comprised of a carved hippopotamus ivory plate into which human teeth – along with parts of both horse and donkey teeth – were placed.

Related reading: Presidential false teeth: The myth of George Washington’s dentures, debunked

George Washington

While the use of porcelain teeth aimed to provide a more durable, esthetic material, human teeth remained widely used. The grisly reality was that human teeth – also known as “Waterloo teeth”, so-called because they were harvested from as many as 50,000 dead soldiers after the 1815 battle of Waterloo – were at much higher demand. Waterloo teeth were affixed into an ivory base. In addition to Waterloo teeth, human teeth were extracted from executed criminals, or even sold by poor people who were desperate to make some money.

In 1820, Claudius Ash, English silversmith and goldsmith, honed the process further by mounting porcelain teeth on 18 karat gold plates with gold springs and swivels. These were superior both esthetically and functionally to older models, but were notoriously difficult to clean.

Denture bases got a quality upgrade in 1850 with the introduction of vulcanite, a form of hard rubber into which porcelain teeth were set. In the 20th century, acrylic resin and other plastics became the materials of choice. The latest chapter in the evolution of dentures in being written now with the advent of CAD/CAM and 3D printing.

 

Article from: Dental Products Report

Wearing Dentures Overnight Tied to Pneumonia

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Wearing Dentures Overnight Tied to Pneumonia

Pneumonia and oral inflammation were more likely in older adults who slept in dentures

(RxWiki News) Dentures can help the elderly maintain a normal lifestyle and diet in spite of age-related dental health problems. But the false teeth can also pose a risk for serious illness if proper oral hygiene isn’t followed.

Researchers in Japan found that elderly patients who slept with their dentures in had more than double the risk of developing pneumonia than those who removed dentures before bed.

The new study also linked overnight denture use with dental plaque, gum inflammation and other oral health issues.

“This study makes intuitive sense, because not only does the wearing of denture prostheses during sleep foster oral bacterial growth, but just as any other foreign body in the mouth, can also predispose to aspiration [breathing in] of saliva,” said Mark Bornfeld, DDS, who has run a private dental practice in Brooklyn, NY since 1977 and is editor at the Queens County Academy of General Dentistry. “It is helpful to have this additional support for dentists’ standard admonishment to their denture patients that dentures should not be worn during sleep.”

The researchers wrote that their study showed the importance of oral hygiene programs for pneumonia prevention in elderly people.

“These results suggest that simple denture care habits could reduce the risk of pneumonia in the community,” they wrote.

According to Dr. Bornfeld, who was not involved in this study, “The directive to keep dentures out of the mouth during sleep is mostly intended to improve general oral hygiene and to reduce the incidence of proliferative inflammatory changes in the denture bearing tissues.” Dr. Bornfeld explained that certain types of gum damage — such as epulis fissuratum and papillary hyperplasia — are known to result from round-the-clock denture wearing. He said that the risk of pneumonia is just as good of a reason to avoid wearing dentures through the night.

For this study, lead researcher Toshimitsu Iinuma, DDS, PhD, of the Nihon University School of Dentistry in Japan, and colleagues studied 524 patients who were 87.8 years old on average.

The seniors had an oral health exam and answered questions about dental hygiene. The study authors followed up yearly with the seniors until they were hospitalized for or died from pneumonia.

Pneumonia is a lung infection that affects breathing. Symptoms include cough, fever, chills and shortness of breath.

During the three-year follow-up, 20 patients died of pneumonia, and another 28 were hospitalized for it.

The study group included 453 denture wearers. Of those who wore dentures, 186 (40.8 percent) wore them during sleep.

Dr. Iinuma and colleagues found that overnight denture wearers had a 2.3 times higher risk of pneumonia than people who removed their dentures before sleep.

“Because pneumonia is such a prevalent issue in the elderly, I have little doubt that it is a concern for physicians,” Dr. Bornfeld said. “I am unsure whether they would be generally aware of the role that nocturnal denture wearing might play as a cause.”

In a companion editorial, Frauke Mueller, PhD, of the University of Geneva in Switzerland, wrote that oral hygiene is especially important for older people.

“When possible, denture wearing during the night should be discouraged in geriatric patients,” Dr. Mueller wrote.

Dr. Bornfeld offered his tips for denture hygiene. “What’s good for natural teeth is good for dentures,” he said.

“There is no adequate substitute for daily brushing of all denture surfaces with a brush. Effervescent tablets are not nearly as effective at removing adherent bacterial plaque,” Dr. Bornfeld said.

“Dentures should be kept submerged in fresh tap water while they’re out of the mouth to prevent warpage, which can happen if they’re allowed to dry out,” he said. “Dentures may be periodically disinfected by soaking them overnight in liquid laundry chlorine bleach diluted one part to ten parts of water (avoid doing this more than once a month if the denture has metallic clasps, to avoid corrosion).”

“Finally,” he said, “if tartar accumulates on the denture, it can be softened for easy removal with an overnight soak in white distilled vinegar (don’t get fancy with balsamic vinegar unless you like brown denture teeth).”

The study by Dr. Iinuma and colleagues was published online Oct. 7 in the Journal of Dental Research.

The Japan Society for the Promotion of Science, Nihon University School of Dentistry, the Japan Health Foundation for the Prevention of Chronic Disease and other public health organizations funded the research. The authors disclosed no conflicts of interest.

 

Article by: Rwiki.com

The Connection Between Erections and Gum Disease

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Chronic gum disease is a newly identified risk factor for erection trouble.

Since the millennium, medical researchers have increasingly focused on the role of chronic inflammation in health problems, particularly in heart and blood vessel (cardiovascular) disease. Inflammation anywhere in the body triggers a cascade of biochemical changes in the bloodstream that help the body repair inflamed tissues. But when inflammation becomes chronic, blood chemistry never returns to normal. Trouble ensues—notably increased risk of heart attack and stroke.

Chronic inflammation of the gums is popularly known as gum disease and medically as periodontitis. Symptoms include: puffy red gums, inflamed, swollen, or bleeding gums, gums pulling away from teeth, and bad breath caused by gum cell death. Recent studies show that periodontitis is a significant risk factor for erectile dysfunction (ED).  And as gum disease gets worse, so does erection impairment:

• Israeli researchers surveyed the erection function of 305 men, average age 40, and then examined their gums. Those with chronic periodontitis had the greatest risk of ED.

• Turkish investigators studied 162 men, age 30 to 40—82 with normal erection function (controls), and 80 who complained of ED. Some men in both groups had chronic periodontitis, but the condition was more than twice as prevalent in the ED group. And the men with periodontitis who also had decayed or missing teeth, another cause of chronic inflammation, showed the most ED.

• Chinese scientists crunched numbers from several studies involving a total of 213,076 men. Compared with those who had good erection function, those with ED had three times the risk of periodontal disease.

This finding makes epidemiologic sense. Periodontal disease has emerged as an independent risk factor for cardiovascular disease, and cardiovascular disease raises risk for ED. Pretty much everything that raises risk for cardiovascular disease also increases risk of ED: smoking, obesity, chronic stress, high cholesterol, high blood pressure, and chronic sleep apnea. So it should come as no surprise that periodontal disease raises risk of ED.

This finding also makes biochemical sense. During sexual arousal, the body releases nitric oxide, which plays a key role in enabling erection. Chronic inflammations, including periodontal disease, impairs release of nitric oxide and contributes to ED.

Robust sexuality depends on robust overall health. As cardiovascular health issues develop—those listed above and now including chronic gum disease—erection ability suffers, and as health problems increase in number and severity, so does the severity of ED.

What should men do?

• Look in the mirror. Around 10 percent of adults have gum disease. If your gums look puffy, shiny, red, or inflamed, and if they bleed easily, chances are you have periodontitis.

• Floss daily. Flossing removes bacteria in the gums that may elude brushing. Those bacteria cause periodontitis. According to the National Center for Health Statistics, only around one-third of American adults floss daily. It takes just a few minutes a day to floss well. Aren’t your erections—or your man’s—worth the effort?

• See a dentist regularly. According to the Centers for Disease Control and Prevention, only around two-thirds of American adults see dentists regularly. That’s understandable. Man people don’t have dental insurance. Dental care is expensive. And apart from toothaches and dental injuries, it’s easy to ignore dental care. But if you do, your erections—or your boyfriend’s or husband’s—may suffer.

• Drink green tea. Green tea is unusually high in antioxidant nutrients that help prevent cardiovascular disease, cancer, and many other conditions associated with aging. Green tea also helps combat inflammation and has been shown to reduce risk of gum disease.

References

https://www.cdc.gov/nchs/fastats/dental.htm

Chatterjee, A. et al. “Green Tea: A Boon for Periodontal and General Health,” Journal of the Indian Society for Periodontology (2012) 16:161.

Fleming, E.B. et al. “Prevalence of Daily Flossing among Adults by Selected Risk Factors for Periodontal Disease, United States, 2011-2014. Journal of Periodontology (2018) 89:933.

Article from: Psychology Today

GlaxoSmithKline To Buy Novartis Out

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GlaxoSmithKline To Buy Novartis Out Of Joint Venture

How buying Novartis out of Joint Venture will provide GlaxoSmithKline increase focus in Oral Health Products.

Bloomberg News (3/27, Paton) reports GlaxoSmithKline will buy Novartis’ stake in the companies’ joint consumer health venture, which includes pain relievers and cold remedies. In other words, GSK is “doubling down on consumer health,” while Novartis is narrowing “its focus on prescription medicines.”

GSK will pay Novartis $13 billion for the stake. The new bosses of two of Europe’s largest drugmakers are pivoting in different directions.

Chief Executive Officer Emma Walmsley’s Glaxo agreed to pay $13 billion. Novartis’s stake in a joint venture that includes Panadol pain relievers and Theraflu cold remedies.  This agreement will result in more firepower for the Swiss giant’s drug business and acquisitions.

Additionally, Fortune (3/27, Meyer) reports that

“GSK said it would launch a review of its consumer healthcare nutrition products. This will help fund the joint venture buyout, focusing its efforts on  medicines and the oral health category.”

“While our consumer healthcare joint venture with GSK is progressing well, the time is right for Novartis to divest a non-core asset at an attractive price.”.  “This will strengthen our ability to allocate capital to grow our core businesses. It will drive shareholder returns, and execute value-creating bolt-on acquisitions. We continue to build the leading medicines company, powered by digital and data.”, says aid Novartis CEO Vas Narasimhan.

Novartis’s four appointees on the joint venture’s board will step down when the transaction closes.

Telegraph (UK) (3/27, Withers, Torrance)

In addition, “GSK said it was considering a sale of malted drink brand Horlicks its other consumer nutrition products to help fund the takeover. This will, therefore, make the shift division’s focus toward over-the-counter medicine and oral health products such as toothpaste and mouthwash.”

 

Article from: ADA Morning Huddle

Lorin Berland, DDS