Prevention. Part 6: Prevention in the older dentate patient.
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OBJECTIVE: The effect of water fluoridation upon dental erosion/tooth wear in the UK has not been investigated. This study aimed to compare the prevalence of tooth wear in 14-year-old schoolchildren in non-fluoridated and fluoridated districts of North West (NW) England. The influence of deprivation and tooth brushing was also investigated. DESIGN: A random sample of 10% of the 14-year-old population in NW England was selected and stratified according to fluoridation status as determined from water authority postcode listings. METHODS: Tooth wear was scored on the labial, incisal and palatal/lingual surfaces of the 12 anterior teeth and the occlusal surfaces of the first molars. Enamel wear was scored 0, dentine was scored 1 or 2, dependent on whether less than or more than a third of the surface had exposed dentine. Secondary dentine or pulpal exposure scored 3. Townsend deprivation scores were gained from residential post codes. RESULTS: A total of 2,351 children were examined, of which 637 (27%) lived in the one fluoridated district of South Cheshire and 1,714 (73%) lived in 11 non-fluoridated districts. Fifty-three per cent of the children had exposed dentine with significantly more males affected than females (p<0.001). In the fluoridated district, significantly fewer children had exposed dentine on labial and palatal smooth surfaces (p<0.001) but no differences were found for incisal and occlusal surfaces. The interaction of fluoridation and tooth brushing twice per day resulted in a significant (30%) reduction in erosion. Smooth surface wear was more prevalent in children resident in affluent areas. CONCLUSION: Children in non-fluoridated districts are 1.5 times more likely to have smooth surface wear compared with children in fluoridated districts. Fluoridation and use of fluoridated toothpaste twice a day provide added protection from dental erosion. The risk of tooth wear is greater with increasing affluence.
OBJECTIVE: To determine the strength of association (expressed as Odds Ratios) of potential risk factors with erosion and tooth wear in 14-year-old schoolchildren. DESIGN: A random sample of 2,385 children were selected by a stratified two-stage technique based on schools and children. SETTING: Schools in NW England. METHODS: Tooth wear was assessed by one examiner on three surfaces of all 12 anterior teeth (labial, incisal and palatal) and the occlusal surface of all four first molars using a four-point scale. Enamel wear was scored 0, dentine exposure <1/3 scored 1, >1/3 scored 2 and secondary dentine or pulpal exposure, scored 3. A questionnaire enquired about general health, dental health, habits and the frequency of intake of a wide range of foods and drinks. RESULTS: The Odds Ratios for tooth wear on any surface for habits, reflux and certain foods were: bruxism, 1.10; stomach upset, 1.45; pickles 1.86; vinegar 1.36; salt and vinegar crisps 1.33; brown/other sauces 1.57. Similarly, the odds ratios for potentially erosive drinks were: fizzy drinks 1.32; sport drinks 1.58; herbal/lemon tea 3.97. The frequency of intake was bi-modal with 397 children drinking a can per day and 207 drinking two cans per day. A significant number drank acidic beverages at bedtime but this was not associated with dental erosion. CONCLUSION: Although odds ratios greater than unity indicate an association, this was not high for carbonated beverages and many other acidic foods or drinks. Examining at fourteen years may not be ideal, as the determinants of erosion/tooth wear have not acted for long, the indices do not discriminate sufficiently and proportionately few subjects have dentine exposed on smooth surfaces.
BACKGROUND: The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health. AIM: To report the prevalence of three non-carious tooth conditions in children in the UK. METHOD: A representative sample of children five, eight, 12 and 15 years of age were examined by calibrated examiners in schools across the UK. The dental examination included accidental damage to incisors, tooth surface loss (TSL) and enamel opacities (age 12 only). A postal questionnaire sought parental and child views on marks on teeth which could not be removed by brushing. RESULTS: The proportion of children sustaining accidental damage to permanent incisors decreased to 11% of 12 and 13% of 15-year-olds, but the majority of accidental damage remained untreated. TSL was found on 53% of five-year-olds and on approximately a third of 12 and 15-year-olds. There was a statistically significant change for TSL on permanent teeth at age 15 where 27% upper incisors had TSL palatally in 1993 compared to 33% in 2003. Thirty-four per cent of 12-year-old children had enamel opacities on one or more of their teeth compared with 36% in 1993. CONCLUSIONS: Tooth surface loss remains a common finding in children in the UK. A large proportion of accidental damage to teeth remains untreated.
The aim of this study was to assess the clinical performance of a resin-modified glass-ionomer cement (Vitremer) and two polyacid-modified resin composites (F2000 and Freedom) over 1 year. Nineteen patients with at least three cervical lesions were selected, providing an initial sample size of 87 restorations (29 per material), being 78 to non-carious and nine to carious lesions. Restorations were evaluated at baseline, 6 months and 1 year after placement, using modified US Public Health Service criteria: colour match, marginal discoloration, caries, anatomical form, marginal integrity and surface texture. At baseline, restorations were considered as acceptable for all criteria. At 1-year recall, 21 restorations per material were re-examined. Freedom was rated Bravo or Charlie for all the examined criteria and Vitremer earned an Alfa rating solely for the criterion caries. On the contrary, F2000 showed the best overall results, although presenting significant alteration in colour match. Statistical analysis of data was performed using chi-square and Mc Nemar tests. As to the evaluated periods, significant difference was observed solely between baseline and 1-year recall. Freedom and Vitremer were statistically different (P < 0.01) as to anatomical form and surface texture. For F2000, significant difference (P < 0.05) was noticed as to colour match and anatomical form. After 1-year follow-up, F2000 showed the most acceptable results as to the analysed criteria.
A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.
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This article describes the occlusal rehabilitation of a partially edentulous patient who did not want a removable partial denture. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result.
STATEMENT OF PROBLEM: Most studies examining tooth wear severity have been performed on dental casts. This indirect approach has limited applicability to dental practice because during the assessment of the casts, the identification of dentin exposure is difficult or even impossible. PURPOSE OF STUDY: The purpose of this study was to assess occlusal and incisal tooth wear clinically to determine the reliability of the assessment procedure and to establish the influence of selected relevant clinical variables (dental quadrant, tooth type, and severity of wear) on the reliability. MATERIAL AND METHODS: Forty-five volunteers (17 men, 28 women; mean age 33.7 +/- 10.7 years), 32 with temporomandibular disorders and 13 free from signs and symptoms of such disorders, were evaluated on 4 occasions. Two trained observers graded tooth wear at 2 different points in time with a 5-point ordinal scale developed for use in this study. The inter-rater and intra-rater reliability of the scale was expressed as Cohen's kappa. The influence of 2 clinical variables, dental quadrant and tooth type, on the values of kappa was tested with 1-way analysis of variance and post hoc Bonferroni tests. Probability levels of P< .05 were considered statistically significant. The influence of the final clinical variable, severity of wear, was assessed qualitatively. RESULTS: The overall values of the inter-rater and intra-rater reliability were substantial (kappa = 0.632 to 0.678). The clinical variable dental quadrant did not influence the kappa values, whereas the inter-rater reliability during the first session was better for incisors and canines than for premolars (1-way analysis of variance: F(3,23)=4.577, P=.012; post hoc Bonferroni tests: P=.030 and.036). Qualitative assessment of severity of wear indicated that the more advanced the tooth wear, the more reliably it could be graded. CONCLUSION: By means of the developed 5-point ordinal scale and within the limitations of this study, it was concluded that tooth wear can be assessed reliably in the clinical dental setting.
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The study of teeth is very important in archaeoanthropology for reconstruction of the nutritional habits and living conditions of past populations. We have analysed dental lesions of pathological (caries, abscesses and ante mortem tooth loss) and non-pathological origin (calculus), linear enamel hypoplasia and tooth wear in 67 adults from the Roman Imperial age necropolis (1st-4th c. AD) of Quadrella (Molise, Italy). The high frequency of caries (likely giving rise to the abscesses and ante mortem tooth loss), the abundant calculus and the low frequency of heavy wear are probably due to a limited use of hard fibrous foods and a high consumption of carbohydrates. The high frequency of linear enamel hypoplasia suggests metabolic problems during growth. Comparison of these data with those for two coeval Italian necropoleis near Rome (Latium), Isola Sacra and Lucus Feroniae, indicates poorer living conditions in the Quadrella population.
The purpose of this study was to examine ground sections of primary second molars and permanent first molars from the same jaws. Teeth from 11 individuals were collected from archaeologic sites in Sweden and Denmark. Longitudinal buccolingual sections were examined in a polarization light microscope and in a Philips scanning electron microscope (SEM). The seven teeth from Sweden appeared to have been subjected to environmental influences at their burial site, which had affected both the dentin and the enamel. The teeth from the Danish sites had a normal color, and no disintegration of the dentin was seen. The general morphologic appearance was normal in all primary and permanent teeth. The position of the neonatal line indicated a normal full-term gestational age. The observed accentuated incremental lines in both the primary and permanent enamel suggested periods of dietary changes, possibly related to periods of illness. SEM images of the surface area of the Swedish teeth showed an extremely porous enamel surface with severe changes in the prism structure as an effect of acid penetration. The Danish teeth did not show any marked changes in the enamel.
Eating disorders are often associated with regurgitation of gastric contents into the mouth and dental erosion. In this study the dental status was evaluated in bulimic patients. Thirty-five bulimics, diagnosed in the Outpatient Departments of Psychiatry and Adolescent Psychiatry of the University Central Hospital in Helsinki, and 105 controls matched for age, sex, and educational level were examined clinically, and the factors associated with dental erosion and caries were evaluated in an interview. Severe dental erosion and dental caries were significantly commoner among bulimics than controls. Bulimics commonly had a low salivary flow rate, but other apparent risk factors of dental erosion did not differ from those of controls. A feeling of dry mouth was commoner among bulimics than controls, and bulimics had an increased tooth sensitivity to cold and touch. More should be done to protect teeth from dental erosion among bulimics, because loss of tooth tissue remains even if the eating disorder disappears.
This work discusses the effect of enamel anisotropy in the stress concentration at the cement-enamel junction (CEJ), a probable cause of fracture in enamel leading to abfraction. Usual simplifications when developing computer models in dentistry are to consider enamel isotropic, or that the direction of the prisms is orthogonal to either the dentine-enamel interface or the tooth outer surface. In this paper, a more refined model for the material behavior is described, based on laboratory observation and on the work of Fernandes and Chevitarese. The material description is used in a two-dimensional (2D) finite element model of the first upper premolar, and the analysis is performed for two different situations: vertical loads, typical of normal mastication and horizontal loads, dominant in bruxism. The analyses were performed using a unit load, which under the hypothesis of linear response of the tooth, allows the combinations described in the text to simulate different functional and parafunctional loads. The results indicate that a realistic enamel description in terms of mechanical properties and spatial distribution of its prisms alters significantly the resulting stress distribution. For all cases included in this study, the detailed description of prism orientation and resulting anisotropy led to improved response in terms of stress distribution, even when loading was horizontal.