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Dental disease in the Chinese Yin-Shang period with respect to relationships between citizens and slaves.

Seventy-one skulls from the Yin-Shang period tombs of Anyang, China, were examined for the incidence of observable dental diseases, including dental caries, alveolar bone resorption (an index of periodontal disease), ante-mortem tooth loss and tooth attrition. Because the remains were excavated from tombs with funerary items, the burials are believed to be of Anyang citizens. Our study indicates carious tooth frequency in the Yin-Shang period was rather low (2.9-4.0%). Periodontal disease frequency was 18.3-26.9%, and ante-mortem tooth loss frequency was 2.0-7.5%. To determine the relative prevalence of overall dental health in the Yin-Shang populations, observations from the 42 male crania were compared to those from 183 male crania of slaves from "sacrificial pits" from the Yin-Shang period (Inoue et al. [1992] J. Anthropol. Soc. Nippon 100:1-29). Results from this comparison indicate no apparent difference between social classes in younger age groups. However, in the older ages the rates of the ante-mortem tooth loss, periodontal disease and tooth attrition were significantly higher in the citizen sample. The findings would suggest dietary development in the Yin-Shang period was not dissimilar enough between social classes to induce clear differences in dental diseases at least at younger ages. Conversely, it appears there must have been significant differences between social classes diets in the earlier phase of the Yin-Shang period to produce the differences in dental disease present in the older samples.

Age Factors↗

Investigation and treatment of patients with teeth affected by tooth substance loss: a review.

Tooth substance loss, an increasing problem, may result from erosion, abrasion and attrition, often with more than one of these acting together. Investigation requires a detailed history and examination. The aim of treatment may be prevention of further damage in less affected cases. The treatment of severe tooth substance loss may be complex, especially in view of the reduced amounts of tooth substance which may be available and the need to find space because of the compensatory over-eruption of worn teeth.

Bruxism↗

Tooth mortality in plantation workers and residents in Sri Lanka.

The tooth mortality of 787 Sri Lanka tea plantation workers and residents aged between 15 and 85 yr was studied in terms of missing teeth as well as teeth requiring extraction for various reasons. The mean number of missing teeth per person was 6.7 +/- 9.0. A pattern relating actual tooth loss and tooth loss adjusted to take account of teeth needing extraction was observed. Such adjustment increased the mean number of missing teeth per person by about two teeth in most age groups. The age specific pattern of tooth loss was calculated. There was an abrupt increase in tooth mortality at the ages 45-54. The age specific tooth mortality for the Sri Lankan group was consistently less than for people in several Western countries. These trends were also apparent in the mortality pattern of individual tooth types. Although there was a tendency for more women to be edentulous, a significantly higher proportion of women than men had a full complement of teeth.

Adolescent↗

Treatment of loss of tooth substance using dentine-bonded crowns: report of a case.

This article discusses the treatment of a bulimic patient with severe tooth substance loss. The patient was provided with dentine-bonded crowns in view of the need for only minimal tooth preparation, their potential for good aesthetics and good patient acceptance. The crowns have performed satisfactorily in clinical service for 4 years.

Adult↗

Tooth substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by liquid scintillation.

AIMS: This study investigated the loss of tooth substance (microg) by means of liquid scintillation in combination with profilometric and SEM analyses in order to evaluate the roughness and morphological changes of the root surface before and after instrumentation. METHOD: 40 polished and irradiated bovine root surfaces were scaled in vitro while covered with 50 ml distilled water using a sonic prototype (Periosonic 1/2), a magnetostrictive ultrasonic (Cavitron with Slimline inserts) scaler and a hand curette. Pressures were applied for the Periosonic, Cavitron and hand curette at 500, 500 and 30 g respectively, for 30-s intervals, up to 120 s. Loss of apatite (microg) was determined from the decays/min (32P) of the water samples using the radiochemical method of liquid scintillation. Replicas were made of the specimens for SEM and profilometric analyses. RESULTS: The least substance loss was noted significantly (p<0.01) at all time intervals after Slimline, followed by the fine sonic prototype Periosonic 2, then the Periosonic 1 and finally the hand curette. In contrast, profilometric and SEM analyses revealed the smoothest root surfaces after the hand curette, whereas Cavitron produced a less smooth surface. CONCLUSION: It can be concluded that this method can reveal very precisely small quantities of substance lost and, in combination with SEM analysis and microroughness measurements, be of considerable value in evaluating the aggressiveness and efficacy of periodontal instruments.

Animals↗

A practical approach to the diagnosis and treatment of periodontal disease.

BACKGROUND: Both nonsurgical and surgical periodontal therapies are important in the control of most forms of periodontal disease. Sometimes, nonsurgical therapy is adequate to control the disease in mild cases and to slow progression and maintain periodontal stability in more advanced cases. Other times, both therapies may be indicated to obtain satisfactory results. The author presents treatment guidelines and recommendations for periodontal therapy. METHODS: The author searched the dental literature for information pertaining to periodontal therapy. RESULTS: The author found evidence-based data to support the effectiveness of nonsurgical and surgical periodontal therapy in controlling periodontal disease. Nonsurgical periodontal therapy requires time, effort, and good diagnostic and clinical skills to obtain satisfactory results. The results are determined by evaluating the patient's periodontal disease after active therapy, at which time additional surgical or nonsurgical treatment may be recommended. Evaluation should continue throughout the lifelong supportive phase of periodontal therapy. CONCLUSION: Clinicians should continue to develop and enhance their diagnostic skills, assess factors that affect diagnosis and prognosis, formulate a comprehensive treatment plan, render appropriate treatment, evaluate the outcome and determine when periodontal care is indicated. CLINICAL IMPLICATION: Failure to comply with monitoring the patient's periodontal status may lead to uncontrolled disease and eventually premature tooth loss. Premature tooth loss can be prevented through patient education and application of evidence-based nonsurgical and surgical therapy.

Clinical Protocols↗

[Osteoporosis].

Osteoporosis is an increasing major skeletal disease leading to disability. It is important to define this disease precisely, because the start is without any symptom in many cases. Causal factors are reviewed as also recognisable risk factors in early stage. The available recent literature and own studies did not show relationship between tooth loss, bone loss of the mandible, periodontitis and osteoporosis. However, corticosteroids diminish mandibular bone mass. Assessment to bone mineral density is a major diagnostic test for osteoporosis prediction. Recent findings in prevention and treatment of osteoporosis are reviewed extensively. The positive results of oestrogen replacement therapy on the oral bone loss and tooth loss from some large observational American studies are interesting.

Adrenal Cortex Hormones↗

Longitudinal validation of a risk calculator for periodontal disease.

BACKGROUND: Risk assessment and utilization of the results are important components of prevention, diagnosis and treatment of periodontal diseases. Risk assessment is relatively new to dentistry. Currently risk is assessed by subjective evaluation and results vary widely among clinicians. We have developed a computer-based risk assessment tool, the Periodontal Risk Calculator (PRC), for objective, quantitative assessment of risk. The purpose of the study reported here was to evaluate the accuracy and validity of this tool. METHODS: Clinical records and radiographs of 523 subjects enrolled in the VA Dental Longitudinal Study of Oral Health and Disease, covering a period of 15 years, were used. Information from baseline examinations was entered into the risk calculator and a risk score on a scale of l-5 for periodontal deterioration was calculated for each subject. Actual periodontal status in terms of alveolar bone loss determined using digitized radiographs, and tooth loss determined from the clinical records, was assessed at years 3, 9 and 15. The strength of the association between risk prediction and actual outcome was determined statistically. RESULTS: The risk scores were strong predictors of future periodontal status measured as worsening severity and extent of alveolar bone loss and tooth loss, especially loss of periodontally affected teeth. Over the entire 15-year period, risk scores consistently ranked groups from least to most bone loss and tooth loss. Risk groups differed greatly from one another. By year 3, the incidence rate of bone loss of group 5 was 3.7-fold greater than for group 2, and by year 15, the loss of periodontally affected teeth was 22.7-fold greater than for group 2 (p<0.001). By year 15, 83.7% of subjects in risk group 5 had lost one or more periodontally affected teeth compared to 20.2% of subjects in group 2. CONCLUSIONS: Risk scores calculated using the PRC and information gathered during a standard periodontal examination predict future periodontal status with a high level of accuracy and validity. Use of the risk assessment tool over time may be expected to result in more uniform and accurate periodontal clinical decision-making, improved oral health, reduction in the need for complex therapy and reduction in health-care cost.

Adult↗

Management of tooth tissue loss from erosion.

Erosive tooth wear appears to be no less frequent in the United States than in the United Kingdom and Europe and is of increasing concern as a significant cause of tooth destruction in younger persons. Consumption of numerous dietary sources of acids is increasing in modern societies. In addition, involuntary regurgitation may be a significant cause of tooth erosion. These primary causes can be exacerbated by xerostomia, which is induced by many drugs. Initial preventive treatments are directed at neutralizing the effects of the acids, and initial restorative treatments should be conservative, using adhesive materials. Treatment of advanced tooth tissue loss is difficult and expensive, and preventive management is emphasized.

Acids↗

Longitudinal evaluation of loss of attachment in HIV-infected women compared to HIV-uninfected women.

BACKGROUND: The Women's Interagency HIV Study (WIHS) is the largest, most detailed, controlled longitudinal collection of data to evaluate the influence of human immunodeficiency virus (HIV) disease and its therapies on the periodontium. METHODS: This report evaluates periodontal probing depth (PD), attachment loss (AL), and tooth loss from 584 HIV-seropositive and 151 HIV-seronegative women, recorded at 6-month intervals from 1995 to 2002. Using the random split-mouth method, PD and AL were recorded from four sites per tooth: mesial-buccal, buccal, distal-buccal, and lingual. Influence of viral load, CD4 count, race, smoking, drug use, low income, and level of education were evaluated. RESULTS: At baseline, AL was 1.6 versus 1.1 mm (P = 0.003) and PD was marginally deeper (2.1 versus 2.0 mm; P = 0.02) in HIV-seropositive versus HIV-seronegative women. Adjusted longitudinal analysis showed that HIV infection did not increase the mean PD (rate ratio [RR], 1.00; 95% confidence interval [CI], 0.96 to 1.04), worst PD (RR, 1.03; 95% CI, 0.98 to 1.09), mean AL (RR, 0.97; 95% CI, 0.96 to 1.02), worst AL (RR, 1.01; 95% CI, 0.94 to 1.07), or tooth loss (RR, 1.02; 95% CI, 1.0 to 1.05). CONCLUSIONS: CD4 count and viral load had no consistent effects on PD or AL. Among HIV-infected women, a 10-fold increase in viral load was associated with a marginal increase in tooth loss. The progression of periodontal disease measured by PD and AL did not significantly differ between HIV-infected and HIV-uninfected women. The HIV-seropositive women lost more teeth. Race, smoking, drug use, income, and education level did not influence the results for either group.

Adolescent↗

A study on factors associated with pathologic tooth migration.

The purpose of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration (PTM) among periodontal patients and to investigate the relationship and degree of association between PTM and the following factors: bone loss, tooth loss, gingival inflammation according to the gingival index, age, lingual interposition, parafunctions and oral habits. 852 periodontal patients (36.7% male, 63.3% female) whose ages ranged from 19 to 72 years (mean 42.5 +/- 9.9) were studied. PTM was defined as the presence of a developing diastema in the upper anterior sextant, which was not present in the past or already existed but increased. Statistical analysis was performed using the Wald test and the Mantel-Haenszel test. Estimates odds ratio were also calculated to assess increased PTM probability as a function of a single variable, or a combination of several. PTM prevalence of 55.8% was found, and it was statistically associated with bone loss (p<0.001), tooth loss (p<0.001) and gingival inflammation (p<0.001), while no association was observed with the remaining variables. The odds ratio indicated that PTM probability increased between 2.95 to 7.97 times as bone loss increased. For tooth loss this probability increased 2.76 times when no tooth loss was compared to 4 or more teeth lost. Likewise the probability increased 2.23 times when the gingival index was above 2. According to the single effect as well as the combined effect of these 3 main factors, it was concluded that: (1) no single factor by itself is clearly associated with PTM: (2) the factor mainly related to PTM is bone loss, followed by tooth loss and gingival inflammation: (3) as bone loss increases, the association of additional factors with PTM, such as tooth loss and gingival inflammation, increases.

Adult↗

Dental pathology in Pongo satyrus borneensis.

The Selenka orangutan collection obtained from 1892 to 1896 from wild-shot specimens in West Borneo, provides an excellent opportunity to examine dental pathology in free-ranging primates. Two hundred and twenty-three skulls from this collection were analyzed for dental conditions, including carious lesions, local infections (infra-alveolar and periapical osseous defects), horizontal bone loss, and premortem tooth loss. Specimens were sexed, divided into three broad age groups, and compared to ascertain sex-related or age-related differences in occurrence of dental pathology. None of the subadults displays any evidence of dental disease. One individual (2%) in the young adult group has a periapical osseous defect and evidence of horizontal bone loss, and another (2%) has two adjacent interproximal carious lesions. The old adults have a much higher prevalence of individuals afflicted with dental pathologies, including 6% carious lesions, 26% local infections, 23% horizontal bone loss, and 3% premortem tooth loss. The differences between the young and old adults in number of individuals afflicted with dental pathologies is statistically significant for local infections and horizontal bone loss. When compared by sex, the old adult group reveals that females have a higher occurrence of dental pathologies than males in all types of lesions recorded and these differences are statistically significant for local infections and horizontal bone loss. Considering the importance diet plays in the development of dental disease, it is suggested that ecological separation of the sexes, with the subsequent dietary differences, could be an important factor determining the higher prevalence of dental lesions observed in female orangutans. Additionally, the importance of local ecological factors, which may affect dietary patterns, are recognized as a potential source of variation in dental pathologies among different samples of orangutans.

Age Factors↗

Validity and accuracy of a risk calculator in predicting periodontal disease.

BACKGROUND: Research on the pathobiology of periodontal diseases has increased our knowledge of these diseases and is fostering a transition from the repair model to the medical or wellness model of periodontal care. Successful application of the wellness model depends on an accurate and valid assessment of disease risk, as well as institution of risk reduction as an integral part of prevention and treatment. A computer-based risk assessment tool has been developed. METHODS: The authors reviewed clinical records and radiographs of 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study to evaluate the validity of risk prediction using the computer-based tool. Data from baseline examinations was entered into the risk calculator, and a risk score on a scale from 1 (lowest risk) to 5 (highest risk) was calculated for each subject to predict periodontal deterioration. Actual periodontal status in terms of alveolar bone loss (determined from digitized radiographs) and tooth loss (determined from clinical records) was assessed at years 3, 9 and 15. The authors determined the statistical strength of the association between risk prediction and actual outcome. RESULTS: The risk scores were strong predictors of periodontal status, as measured by alveolar bone loss and loss of periodontally affected teeth. Risk scores consistently ranked risk score groups from least to most bone loss and tooth loss. Compared with a risk score of 2, the relative risk of tooth loss was 3.2 for a risk score of 3, 4.5 for a risk score of 4 and 10.6 for a risk score of 5. CONCLUSIONS AND PRACTICE IMPLICATIONS: Use of the risk assessment tool over time may result in more uniform and accurate periodontal clinical decision-making, improved oral health, reduction in the need for complex therapy, reduction in health care costs and a hastening of the transition from a repair model to a wellness model of care.

Alveolar Bone Loss↗

Rehabilitating a patient with bruxism-associated tooth tissue loss: a literature review and case report.

Tooth tissue loss from bruxism has been demonstrated to be associated with various dental problems such as tooth sensitivity, excessive reduction of clinical crown height, and possible changes of occlusal relationship. A literature search revealed a number of treatment modalities, with an emphasis on prevention and rehabilitation with adhesive techniques. Rehabilitating a patient with bruxism-associated tooth tissue loss to an acceptable standard of oral health is clinically demanding and requires careful diagnosis and proper treatment planning. This article describes the management of excessive tooth tissue loss in a 43-year-old woman with a history of bruxism. The occlusal vertical dimension of the patient was re-established with the use of an acrylic maxillary occlusal splint, followed by resin composite build-up. Full-mouth oral rehabilitation ultimately involved constructing multiple porcelain veneers, adhesive gold onlays, ceramo-metal crowns, and fixed partial dentures.

Adult↗

Cigarette smoking, salivary/gingival crevicular fluid cotinine and periodontal status. A 10-year longitudinal study.

BACKGROUND, AIMS: The primary purpose of this study was to determine the association of salivary and gingival crevicular fluid (GCF) cotinine levels with periodontal disease status in smokers and non-smokers. METHODS: 147 male smokers and 30 male non-smokers were included in the current longitudinal study. The 177 individuals were part of a group of 200 subjects (89%) seen 10 years previously for a baseline survey. Oral hygiene indices, probing depth and attachment loss were recorded. Salivary and GCF cotinine levels of 58 smokers were determined by means of ELISA. RESULTS: Results indicated that no significant difference was found in subjects who smoked, when compared to subjects who did not smoke with respect to plaque accumulation and calculus deposits. Smokers, however, had fewer gingival bleeding sites. Cigarette smoking was associated with a greater increase in probing depth and attachment loss, as well as greater tooth loss at an earlier age. There was greater tooth loss in smokers than non-smokers (p < 0.001). 11 smokers became edentulous, while only 1 non-smoker lost all his teeth within 10 years. The degree of periodontal tissue breakdown was different in each age group with greater periodontal deterioration as age increased. All smokers had detectable salivary and GCF cotinine. Mean GCF cotinine was about 4x higher than mean salivary cotinine levels. Individuals who smoked > or = 20 pack years when compared to <20 pack years, had significantly higher saliva and GCF cotinine levels (p < or = 0.05). CONCLUSION: Neither salivary cotinine nor GCF cotinine was significantly correlated with probing depth, attachment loss and tooth loss (p > 0.05).

Adult↗

Radiological evaluation of marginal bone loss at tooth surfaces facing single Brånemark implants.

A radiologic evaluation of marginal bone loss around single implants ad modum Brånemark and their adjacent teeth was performed: 58 adults with 71 fixtures were followed up to 3 years after crown installation. The following factors were considered: age, cause of tooth loss, vertical relation between fixture and teeth, distance between adjacent teeth, distance between fixture and natural tooth, jaw region. Specified distance were measured as well as marginal bone levels around fixtures and tooth surfaces in magnified standardized intraoral radiographs. The results show a loss of marginal bone support at tooth surfaces adjacent to inserted implants during the interval between preoperative examination and crown installation that exceeds the loss during subsequent years. The largest bone loss was observed when implants were placed next to lateral upper incisors. A strong correlation was found between bone loss at adjacent teeth and the horizontal distance fixture-tooth. With decreasing distance the bone loss increased, especially in the upper incisor region. At present it seems difficult to predict which individual or individual condition may have a higher risk for bone loss, due to large intra- and interindividual variation.

Adult↗

Occupational tooth abrasion in a dental technician: loss of tooth surface resulting from exposure to porcelain powder--a case report.

A dental technician suffered abrasion of his anterior teeth because of his technique of handling porcelain powder during the construction of restorations. To keep the brush moist, he habitually licked it as he applied porcelain powder to restorations. The porcelain powder, which is extremely abrasive, acted as a grinding powder between his maxillary and mandibular anterior teeth. Adjunctive orthodontics and a combination of adhesive, minimal-intervention restorations were used to create an esthetic and functional solution.

Adult↗

Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002.

PROBLEM/CONDITION: Dental caries is a common chronic disease that causes pain and disability across all age groups. If left untreated, dental caries can lead to pain and infection, tooth loss, and edentulism (total tooth loss). Dental sealants are effective in preventing dental caries in the occlusal (chewing) and other pitted and fissured surfaces of the teeth. Enamel fluorosis is a hypomineralization of enamel related to fluoride exposure during tooth formation (first 6 years for most permanent teeth). Exposure to fluoride throughout life is effective in preventing dental caries. This is the first CDC Surveillance Summary that addresses these conditions and practices. REPORTING PERIOD: 1988-1994 and 1999-2002. SYSTEM DESCRIPTION: The National Health and Nutrition Examination Survey (NHANES) is an ongoing survey of representative samples of the civilian, noninstitutionalized U.S. population aged >/=2 months in NHANES 1988-1994 and all ages during 1999-2002. The dental component gathered information on persons aged >/=2 years. RESULTS: During 1999-2002, among children aged 2-11 years, 41% had dental caries in their primary teeth. Forty-two percent of children and adolescents aged 6-19 years and approximately 90% of adults had dental caries in their permanent teeth. Among children aged 6-19 years, 32% had received dental sealants. Adults aged >/=20 years retained a mean of 24 of 28 natural teeth and 8% were edentulous. Among persons aged 6-39 years, 23% had very mild or greater enamel fluorosis. Disparities were noticed across all age groups, among racial/ethnic groups, persons with lower education and income, and by smoking status. From 1988-1994 to 1999-2002, four trends were observed: 1) no change in the prevalence of dental caries in primary teeth among children aged 2-11 years, 2) a reduction in prevalence of caries in permanent teeth of up to 10 percentage points among persons aged 6-19 years and up to six percentage points among dentate adults aged >/=20 years, 3) an increase of 13 percentage points in dental sealants among persons aged 6-19 years, and 4) a six percentage point reduction in total tooth loss (edentulism) among persons aged >/=60 years. INTERPRETATION: The findings of this report indicate that the dental caries status of permanent teeth has improved since the 1988-1994 survey. Despite the decrease in caries prevalence and severity in the permanent dentition and the increase in the proportion of children and adolescents who benefit from dental sealants, disparities remain. PUBLIC HEALTH ACTION: These data provide information for public health professionals in designing interventions to improve oral health and to reduce disparities in oral health, for researchers in assessing factors associated with disparities and dental caries in primary teeth, and in designing timely surveillance tools to monitor total fluoride exposure.

Adolescent↗