Three students from CWRU's School of Dentistry swept first, second and third places in the 21st Annual Arthur Elfenbaum Essay competition, sponsored by the American Society for Geriatric Dentistry, a subgroup of Special Care Dentistry.

photo by Susan Griffith From left to right: Marsha Pyle, associate dean for academic affairs at the dental school, and students Arash Niazi-Sharaki, Michelle Hrnchar and Hema Patel

The winners were Hema Patel for her first-place essay "A Review of Obstructive Sleep Apnea and Mandibular Advancement Devices for the Geriatric Dental Patient; Michelle Hrnchar, second place, "Impact of Abfraction Lesions on the Geriatric Population;" and Arash Niazi-Sharaki, third place, "The Significance of Edentulousness and Nutrition Intake in the Geriatric Population." Each award was accompanied by a monetary prize. While CWRU has had second or third place winners in the past, this is the first time the dental school took first place and also placed in second and third places.

The Elfenbaum competition is open to all dental and dental hygiene students in an accredited U.S. or Canadian dental program. At CWRU, Marsha Pyle, associate dean for academic affairs at the dental school, gave her students in the geriatric dentistry course the choice of writing an enterprising essay that required research for the competition or taking the standard classroom quizzes and tests.

She said most of her students opted to do research for the essays, adding that this shows the motivation of CWRU students to learn beyond the classroom.

Pyle said that the effort promoted education in the area of geriatrics and took a novel approach to learning.

"It was especially nice that students received this recognition for their efforts," Pyle said.

Patel's work looked at sleep apnea in the older population.

"Very little research is available on sleep apnea in the geriatric population," she said. "As people age, sleep apnea becomes more of a health problem."

She explained that dentists can diagnose sleep apnea-or night-time snoring-by looking at the thickness of the neck, excessive fatty tissue in the throat or a thickened tongue. Because many older patients have other medical conditions and take medications, many do not want to undergo invasive surgical procedures to correct the condition. She wrote about using mandibular advancement devices, which thrust the lower jaw forward to open the airways in the throat, as a way to prevent sleep apnea. Dentists have debated what causes abfraction lesions or fissures in the teeth. Some dentists say one cause is excessive brushing of the teeth.

Hrnchar reviewed the literature that looked at the biomechanics and stresses on what the remaining teeth undergo, after tooth loss, that causes them to develop breaks or abfraction lesions. Hrnchar wrote about removable devices and other intervention strategies to keep teeth from moving or breaking as ways to help prevent these lesions after tooth loss.

How poor nutrition correlates with tooth loss concerned Niazi-Sharaki as he began to look at research written about geriatric oral health. He looked at the symptoms of malnourishment such as dry mouth, irritated oral tissues and tongue fissures. He designed a short survey that dentists can give patients that raises the red flag on a poor diet. Among the questions he proposed asking older patients are how often they eat out, how much fruits and vegetables are in their diet, what kinds of food are eaten and whether those foods tend to be soft and higher in fat.