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PubMed1986

Glycogen synthetic abilities of Actinomyces viscosus and Actinomyces naeslundii freshly isolated from dental plaque over root surface caries lesions and non-carious sites.

Relative glycogen synthetic abilities of resting cells of fresh clinical isolates of Actinomyces viscosus and Actinomyces naeslundii originating from dental plaque samples over root surface caries lesions and non-carious sites were studied under anaerobic conditions at a constant pH of 7.0, with U-(14C)-glucose used as the carbon source. Although the rates of glucose utilization and total acid formation were essentially the same, A. viscosus strains isolated from root surface caries lesions showed glycogen synthetic abilities approximately two to seven times higher than did A. viscosus strains originating from non-carious sites, and also two to four times higher than did A. naeslundii strains originating from both carious and non-carious sites.

Acids↗
PubMed1990

An ultrastructural study of bacterial invasion and tissue breakdown in human experimental root-surface caries.

This study describes the structural features of the interface between microbial deposits and root cementum in actively progressing root-surface caries lesions developed experimentally in six elderly individuals. A total of 18 specimens was examined by microradiography, and a further 18 by light and transmission electron microscopy after intra-oral periods of one, two, and three months. All specimens showed various degrees of subsurface dissolution of mineral and bacterial invasion of the cementum. Although the microradiographic pattern of mineral loss was subsurface in nature, transmission electron microscopy showed dissolution of crystals in the outermost layers of the cementum, with a distinct gradient inward. Bacterial invasion occurred along the borders between bundles of relatively well-mineralized extrinsic collagen fibers in which the characteristic cross-banding remained intact. The pattern of bacterial invasion was influenced by the incremental lines and the cemento-dentinal junction. The invading bacteria were almost exclusively Gram-positive, of various shapes, and possessed thick, moderately electron-dense cell walls and electron-lucent "vacuoles" in the cytoplasm. It is concluded that because of pronounced mineral loss of the outermost cementum, accompanied by bacterial invasion, the surface of an active cementum caries lesion, as observed by transmission electron microscopy, is not identical to that seen in microradiograms.

Aged↗
PubMed1989

Methodological issues relative to the quantification of root surface caries.

The purpose of this study was to assess the effect upon the quantification of root surface caries (RSC) of (1) the separation of the disease into its discrete clinical phases, (2) the confounding caused by the presence of restored abraded surfaces, and (3) the decision rule formulated for dealing with lesions and restorations which involve both crown and root. It was found that the apparent prevalence of RSC varied widely depending upon arbitrary decisions as to what stages of the disease were included in the measurement scheme. The addition of restorations (confined to the root) greatly enlarged the various disease measures, but probably also introduced some degree of error since there are several indications from the data and the clinical patterns of affected surfaces which suggest that some of the restored surfaces were formerly abraded rather than carious. The inclusion of lesions and restorations involving both root and crown produced another conspicuous increment in all disease measures, which is a cause for concern given that these components are included in some studies and ignored in others. These findings serve as the basis for several recommendations for future prevalence and incidence studies of RSC.

Adult↗
PubMed1991

Active and inactive root surface caries lesions in a selected group of 60- to 80-year-old Danes.

In 90, 60- to 80-year-old patients with teeth retained in both jaws (mean 20.4 +/- 4.3), a total of 1,092 root surface lesions were recorded. Of these 156 were diagnosed as active caries lesions, whereas 509 were considered inactive, and 427 were filled. About 60% of the elderly had one or more active lesions and 79% had fillings. Seventy percent had more than 8 filled or carious (active or inactive) surfaces. The percentage of carious and filled root surfaces in relation to surfaces at risk demonstrated that the buccal surfaces of lower molars and premolars and upper canines were the most severely affected (RCI = 70%) with fillings predominating on easily accessible surfaces. A constant relationship between active and inactive lesions was found on all other surfaces but third molars and upper incisors. The data suggest that active and inactive root caries lesions must be diagnosed as separate entities if the dynamic nature of root surface caries is to be explored in epidemiological studies and clinical trials.

Aged↗
PubMed2002

Influence of cementum on the demineralization and remineralization processes of root surface caries in vitro.

The influence of the nature of the root surface on the demineralization and remineralization processes within artificial fluoride-treated caries lesions was investigated using microscopic and X-ray microanalytical methods. Traces of fluoride were detected in the outer parts (about 25 micrometers) of the lesions after the application of fluorides, and a high mineral content was proved for the same region by means of microanalytical calcium estimation. The location of this mineral-rich band in relation to the root surface was deeper into the root depending on the existence and thickness of a cementum layer. However, within the dentine the location and intensity of the mineral content were unaffected by the cementum. Investigation of artificial caries lesions without fluoride treatment showed the following: The degree of mineralization was kept at a higher level near the root surface in the presence of cementum. Consequently, a cementum layer gives some initial caries resistance of the root surface.

Amines↗
PubMedDate not supplied

The dental status of dentate institutionalized older adults: consideration of retained roots.

Many studies have described the general dental findings in institutionalized older patients, but few studies have used standard dental indices to describe the dental status of these populations. Eighty-five dentate nursing home residents were examined by a single dentist. Dental findings were reported by means of the DMFS, DMFT, and RCI indices along with the D/DFS ratio for coronal and root caries. The mean DMFS, DMFT, and RCI were 97.0, 22.9, and 28.7%, respectively. The percentages of untreated coronal and root caries lesions, as measured by the D/DFS ratios were 65.4% and 85.4%, respectively. Forty-eight percent of the subjects had at least one retained root, with a mean of 1.0 for all 85 subjects. None of the dental findings was statistically significant in association with age, gender, or length of stay in the institution. In the population examined, no statistical or clinical differences in relation to age, gender, or length of stay in the institution were found. The dental status of a dentate older adult population can be accurately described by means of the standardized indices of DMFS, DMFT, and RCI along with the D/DFS ratios, with the caveat that these indices must be interpreted differently than when used with pediatric populations. Retained roots present a fifth surface at risk for root caries, the occlusal surface. The role of the occlusal root surface in the dental status of a population needs to be reported and analyzed.

Age Factors↗
PubMed1993

Oral health status, treatment needs and demands of an elderly institutionalised population in Athens.

Oral health status, treatment needs and demands were investigated among 242 elderly people (63 males and 179 females) living at the largest residential home in Athens. The mean age of the sample was 83.8 years (82.8 males and 84.1 females). The oral health status was generally poor, 64.4% of the population were edentulous while 16.1% of them lacked dentures in both jaws. 43.2% of the subjects presented with denture-induced pathology of the oral mucosa, requiring either conservative or surgical treatment. The dentate subjects had an average of 12.3 teeth with 4.2 teeth requiring extraction and 2.2 teeth with coronal restorable caries. The mean Root Caries Index was found to be 18.5%. The assessment of the periodontal treatment needs according to the CPITN revealed that 9.3% of the dentate subjects needed only oral hygiene instruction, 61.5% professional scaling and 20.9% more complex periodontal treatment. Although the total percentage of subjects needing some form of dental treatment was 85.1%, only 34% of them felt that they required it and only 13.1% had tried to obtain it.

Age Distribution↗
PubMed1999

Effects of mutans streptococci, Actinomyces species and Porphyromonas gingivalis on collagen degradation.

BACKGROUND: While Streptococcus mutans and Actinomyces spp are considered to be major pathogenic microorganisms of root caries, their roles in the degradation of organic matrix components of human root dentin need clarification. METHODS: Ten laboratory strains and 11 clinical isolates of mutans streptococci and Actinomyces species, and positive bacterial or purified enzyme controls (Porphyromonas gingivalis whole cell lysates, trypsin or clostridial collagenase) were used to establish the degradation of azocollagen (AC), insoluble type I collagen (IC) or human dentin collagen (DC) from dentin powder in two types of experiments investigating collagenolytic activity either during or after bacterial growth. Ultraviolet-irradiated dentin powder and gamma-irradiated IC were used to assess the collagenolytic activity of test strains during bacterial growth. AC, IC and acid-treated dentin powder were used to determine the collagenolytic activity of sonicated bacterial whole cells and cell-free culture supernatants recovered from test strains after growth. Hydroxyproline or spectrophotometric assays were used to analyze the level of degraded collagen. RESULTS: Data from this study showed that in contrast to the positive controls, none of the laboratory strains or clinical isolates elicited significant degradation of AC, IC or DC. CONCLUSIONS: Results indicated that mutans streptococci and Actinomyces species had no significant collagenolytic activity, but may be involved in the root caries process through other mechanisms. In addition, proteolytic enzymes from other oral bacteria such as Porphyromonas gingivalis or from host cells such as neutrophils may also participate in the pathogenesis of root caries.

Actinomyces↗
PubMed2005

Dental caries, periodontal disease, and cardiac arrhythmias in community-dwelling older persons aged 80 and older: is there a link?

OBJECTIVES: To examine whether caries or periodontitis is associated with cardiac arrhythmias in community-dwelling people aged 80 and older. SETTING: Urban, community-based population in Stockholm, Sweden. DESIGN: Cross-sectional. PARTICIPANTS: Eligible persons were identified through the Kungsholmen Project, which is an ongoing, longitudinal, population-based study of the oldest old. The present study included 125 dentate individuals. MEASUREMENTS: Data from interviews, a medical examination, and an oral examination. The assessment of cardiac arrhythmia was based on a clinical examination by a physician or the Stockholm Inpatient Register. Active root caries, active coronal caries, and periodontitis were assessed using previously defined National Institute of Dental and Craniofacial Research diagnostic criteria. RESULTS: The primary finding of the multivariate logistic regression analysis was that persons with three or more active root caries lesions had more than twice the odds of cardiac arrhythmias than persons without active root caries. The results did not notably change after adjusting for age, medications that reduce saliva, and number of teeth. Persons with one to two active coronal caries lesions had 2.8 times higher odds (95% confidence interval=1.1-7.0) of arrhythmia than persons without active coronal caries, but there was no greater risk for persons with three or more coronal caries lesions. There was no association between periodontal disease and arrhythmia. CONCLUSION: The findings indicate that there may be a link between active root caries and cardiac arrhythmias in the oldest old. Nevertheless, although a biological pathway is not obvious, it is plausible that both are simply markers of declining general health. The results suggest the need for further study of these relationships.

Aged↗
PubMed2003

Xerostomic medications and oral health: the Veterans Dental Study (part I).

OBJECTIVES: To quantify the adverse effects of the number of xerostomic medications on dental caries, oral mucosa, and periodontal disease. DESIGN: Secondary analysis of a cross-sectional study of the Veterans Dental Study. SETTING: Four New England area VA outpatient clinics. SUBJECTS: The sample consists of 345 male veterans participating in The Veteran's Dental Study who also had pharmacy records. MAIN OUTCOME MEASURES: Oral health data included total surfaces of coronal caries, a modification of the root caries index, mean oral mucosa scores, and Community Periodontal Index of Treatment Need (CPITN). Oral health parameters were measured and recorded in clinical dental examinations. EXPOSURES: Intake of xerostomic medications 14-385 days prior to the dental examination. STATISTICAL ANALYSES: The relationships between exposure and outcome were analyzed via linear and logistic regression methods adjusting for possible confounding factors such as disease burden index, alcohol consumption, dental care, and smoking status. RESULTS: Veterans who were taking at least one xerostomic medication were almost three times more likely to have mean mucosa scores in the worst 25 percentile than veterans taking no xerostomic medications, OR = 2.63 (confidence interval [CI] 1.34, 5.16, p = 0.03) after adjusting for age, number of teeth, disease burden index, income, smoking and alcohol use. Participants who were taking at least one xerostomic medication experienced higher but non-significant increases in coronal (OR = 1.21; CI. 0.66, 2.25) and root caries (OR = 1.10 CI. 0.54, 2.24) measured by numbers of total decayed surfaces. CONCLUSION: There were significant deleterious effects of xerostomic medications on oral mucosa. However, xerostomic medications do not appear to increase coronal caries, or periodontal index measured by CPITN among ambulatory, community dwelling participants who were able to perform routine preventive oral care.

Adult↗
PubMedDate not supplied

The use of resin-ionomer in restorative procedures.

As the average age of the population increases, we are seeing a significant rise in root caries and in the need for restorative procedures associated more often with an older population. This paper describes the subgingival placement of a resin-ionomer for several restorative procedures, including root caries, resorption, endodontic perforation and root fracture. After endodontic therapy, full thickness flaps may be used to gain access to the lesion or root defect. The defects may be prepared with ultrasonic instruments and the preparations treated with a dentin conditioner. The preparations are then washed and lightly air-dried and treated with a dentin bonding agent. A resin-ionomer may then be syringed into the preparations and either light-activated or allowed to undergo a chemical set. No untoward effect has been observed during the time frame of this project. The cases presented indicate that a resin-ionomer may be used as a subgingival restorative and may be placed in lesions originally thought to be unrestorable. Thus, teeth may be saved that were previously designated for extraction.

Dental Restoration, Permanent↗
PubMed1995

Examiner agreement on caries detection and plaque accumulation during dental surveys of elders.

Indices used to evaluate plaque accumulation and coronal caries have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of clinical criteria used in coronal and root caries diagnosis and oral hygiene evaluation as applied in elders. Nineteen elderly subjects, 73 years old on average, were examined at a first appointment by two independent examiners. They were re-examined two weeks later. Plaque accumulation was evaluated using the Plaque Index (PI) and coronal and root caries were detected according to the WHO criteria and Fejerskov et al. (1991), respectively. Recurrent caries was recorded as recommended by WHO and by probing at the interface tooth-restoration. Inter- and intra-examiner agreement was evaluated using kappa statistics. The PI score showed good reliability except for examiner b, for whom a simplification of the 4-point scale in 3-point scale improved significantly the reliability. The prevalence of coronal caries was very low and intra- and inter-examiner agreement was poor. Most of the root caries lesions were covered by plaque and the kappa values indicated only poor agreement. Recurrent caries were found with good agreement using WHO criteria but the detection with the probe was not reliable. In conclusion, it seems that examiners should be trained carefully to maximise their reliability and that plaque should be removed to obtain reliable diagnoses of caries. Retraining and calibration may be necessary for surveys continuing over a long period.

Aged↗
PubMed1997

Oral glucose clearance in nonagenarians in relation to functional capacity, medication and oral variables.

OBJECTIVES: To study oral sugar (glucose) clearance and to examine some factors which were believed to either influence or be dependent upon oral glucose clearance. DESIGN: Cross-sectional, clinical study with analysis of records. SETTING: Göteborg gerontological and geriatric population studies, Göteborg University, Sweden. SUBJECTS: 71 community-dwelling individuals, 27 men and 44 women, of a representative sample of 260 92-year-old persons. INTERVENTION AND MAIN OUTCOME MEASURES: Glucose concentration was measured in saliva after chewing of a glucose tablet and the clearance was assessed by three different variables: (i) the initial salivary glucose concentration, (ii) the area under the curve (AUC) and (iii) the clearance time. RESULTS: The glucose clearance showed a wide inter-individual variation, which could be explained partly by differences in oral state, chewing time, stimulated salivary secretion rate and medication use. A positive correlation was found between the clearance variables and the number of lactobacilli and mutans streptococci in saliva and the percentage of untreated root caries lesions of the total number of exposed root surfaces. CONCLUSIONS: A slow oral sugar clearance is more common among 92-year-olds than younger adults earlier reported in other studies, particularly in those who have uncompensated functional impairments and a high medication history. A decreased oral glucose clearance was associated with high counts of salivary lactobacilli and mutans streptococci and a high proportion of untreated root caries lesions.

Aged↗