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Aspiration of oropharyngeal flora is the most common route of acquiring Gram‐negative pneumonia, a major nosocomial infection. Epidemiologic studies indicate that the elderly are at increased risk for developing these life‐threatening pneumonias. The primary objective of this study was to determine the effects of salivary oral defenses against Gram‐negative colonization. The study population consisted of 41 male outpatients, age 70 and older, seen at the Denver VAMC. The group included subjects with both diminished and normal salivary flow. Each subject answered a questionnaire regarding overall health, medication use, and symptoms of salivary dysfunction. We then collected whole saliva, unstimulated and stimulated parotid saliva, and performed a throat swab on each patient. For each throat culture, analysis was done to identify Gram‐negative bacteria. Flow rates between colonized (n = 6) and noncolonized subjects (n = 34) were compared. While there were no significant differences in the flow rates between the two groups, a trend was noticed in that flow rates were lower for all three flow measures in the colonized group (whole, 22% decrease; unstimulated, 22% decrease; and stimulated, 28% decrease). These preliminary findings suggest that subjects with diminished salivary flow may possibly be at Increased risk for oropharyngeal Gram‐negative colonization. Research on the role that saliva plays in oropharyngeal bacterial colonization is continuing

ABSTRACTThe homeless population in the United States is one of great diversity that continues to increase in number. Although data on the oral health status of individuals who are homeless is limited, studies consistently report both the perception and clinical evidence of dental needs among this population as well as a low utilization rate for dental services. This article reviews the oral health needs of people who are homeless as reported in literature, barriers to receiving dental care, and methods used to deliver dental care to this population. Many rehabilitation centers for adults who are homeless consider the establishment and maintenance of a state of good general and oral health as a priority and a key factor in helping homeless adults to return to the workforce and mainstream society.

ABSTRACTPurpose/ObjectivesThe healthcare workforce is challenged with preparing for the increasing number of older persons and complexities of their healthcare needs. Fellowship trained geriatric dentists are charged with the task of addressing the dental needs of this vastly growing cohort.The purpose of this study is to formulate a set of competencies for Geriatric Dental Fellowship Training Programs.MethodsThe Delphi technique—a series of three rounds of anonymous questionnaires to obtain the opinions of experts without bringing them together.ResultsIn Round 1, we proposed 45 competencies based on findings in previous literature. In Round 2, there were 19 respondents whose edits narrowed our list to 39 competencies proposed by the participants. In Round 3, based on group consensus we formulated a final list of 42 competencies.ConclusionUtilizing the Delphi process, a panel of geriatric dental experts identified a set of core competencies for curriculums in dental fellowship programs.

Sixteen patients with caries‐inacthe Sjögren's syndrome with low parotid salivary flow rates (≤ 0.25 mL/min) and 18 caries‐inactive control subjects with higher salivary flow rates were compared. Mutans streptococci (MS) and lactobacilll (LB) counts were measured by means of Dentocult® SM strip mutans and LB assays. The group with Sjögren's syndrome displayed higher counts of MS (P = 0.014) and LB (p = 0.003) when compared with controls. The results of this study indicate that patients with caries‐inactive Sjögren's syndrome and low salivary flow may have higher colonization of cariogenic mlcro‐organisms than healthy individuals.

AbstractAimsThe aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries‐related treatment in high caries risk Veterans.MethodsThis retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009–2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first‐last restoration in the index year.ResultsRoot caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32–40% less likely to receive caries‐related treatment for root caries during the follow‐up period. Once Veterans had root caries, fluorides did not exhibit a positive effect.ConclusionIn older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.

AbstractIntroductionDry socket and infection are complications of tooth extractions. The objective was to determine risk factors for post‐extraction complications in patients without antibiotic prophylaxis stratified by early‐ and late‐complications and complication type (oral infection and dry socket).MethodsRetrospective, case (with complications)‐control (without complications) study of patients (n = 708) who had ≥1 extraction performed at any Veterans Health Administration facility between 2015–2019 and were not prescribed an antibiotic 30 days pre‐extraction.ResultsEarly complication cases (n = 109) were more likely to be female [odds ratio (OR) = 2.06; 95% confidence interval (CI):1.05–4.01], younger (OR = 0.29; 95% CI:0.09–0.94 patients ≥ 80 years old, reference:18–44 years), Native American/Alaska Native (OR = 21.11; 95% CI:2.33–191.41) and have fewer teeth extracted (OR = 0.53 3+ teeth extracted; 95% CI:0.31–0.88, reference:1 tooth extracted). Late complication cases (n = 67) were more likely to have a bipolar diagnosis (OR = 2.98; 95% CI:1.04–8.57), history of implant placement (OR = 8.27; 95% CI:1.63–41.82), and history of past smoking (OR = 2.23; 95% CI:1.28–3.88).ConclusionPredictors for post‐extraction complications among patients who did not receive antibiotic prophylaxis were similar to prior work in cohorts who received prophylaxis. Unique factors identified in a medically complex population included being younger, Native American/Alaska Native, having mental health conditions, history of a dental implant, and fewer teeth extracted.