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PubMed1997

A 5-year study of attachment loss in community-dwelling older adults: incidence density.

This is the second of three papers that present trends in attachment loss and tooth loss over a 5-yr period in a population of community-dwelling elderly black and whites. The first paper in this series showed that in addition to subject attrition during the 5 yr of the study, teeth also were lost. This loss of subjects and teeth resulted in trends that were not always consistent over time, because people were lost from the study and teeth with more active and advanced periodontal disease were more likely to be lost. In these instances, the incidence density (time-to-event) analytic strategy is useful. Incidence density is the average rate of occurrence for a fixed follow-up period. In 1988, the University of North Carolina School of Dentistry initiated the Piedmont 65+ Dental Study, which was designed to elicit 800 dentate respondents in the 5-county area who were examined again at 18, 36 and 60 months. Our findings indicated that for every 1000 sites followed for 1 yr in this population, 20.6 sites will experience attachment loss of 3+mm. Incidence densities varied greatly by subgroup, indicating that certain characteristics predispose sites for attachment loss. A multivariate logistic regression model indicated that people who are smokers, Porphyromonas gingivalis positive, have 5 or more missing teeth, are not high school graduates, and have not had a dental visit in the last 5 yr are at higher risk of attachment loss. Posterior teeth and mesiobuccal sites are at higher risk. We conclude that incidence density analyses are useful for longitudinal periodontal data and we illustrate the use of incidence density rates to plan clinical trials.

Aged↗
PubMed2006

Self-inflicted dental injury presenting as localized anterior tooth surface loss.

UNLABELLED: A case of localized anterior tooth surface loss (TSL) with an unusual aetiology is reported. Whilst suffering from a bout of acute depression and anxiety, a 29-year-old female caused significant trauma to her anterior dentition with a pair of fabric scissors. The presentation and management of this case is described. CLINICAL RELEVANCE: Although tooth surface loss is a common clinical finding in many patient groups, practitioners should be aware of possible unusual aetiologies which may be involved.

Adult↗
PubMed1990

Chairside evaluation of salivary parameters in patients with tooth surface loss: a pilot study.

In cases of tooth surface loss, the possibility of an erosive component should be considered, even when the lesions have the characteristic clinical appearance of abrasion or attrition. Individual susceptibility or resistance to erosive damage has been attributed to variations in the quality of saliva. Two recent studies have indicated that rate of flow of saliva and buffer capacity may be important determinants in erosion susceptibility. These parameters may be readily assessed using the chairside kits developed in Scandinavia for assessing caries susceptibility. In eight consecutive patients referred to the University of Queensland Dental School for investigation of tooth surface loss, six had no measurable quantities of resting whole saliva, four had low values for stimulated saliva flow rates, and only two patients had buffer capacities within the normal range. The results indicate the need for a larger scale study of salivary parameters in this patient group. The chairside kits provide a simple, rapid, hygienic means of assessing salivary values.

Adolescent↗
PubMed2004

Dose-effect relation of smoking and the interleukin-1 gene polymorphism in periodontal disease.

BACKGROUND: Periodontitis is a bacterial inflammatory disease leading to attachment loss with the consequence of tooth loss. There exists a multifactorial risk pattern including bacterial challenge, smoking, age, gender, diabetes, and socioeconomic and genetic factors. Smoking has the highest impact on the course of the disease modulated by all the other factors. Here, we report the relationship between smoking and the genetic polymorphism of interleukin-1 (IL-1). METHODS: In a randomly selected population-based study, we genotyped 1,085 test persons for the IL-1 genotype, examined their periodontal status, and assessed their smoking behavior including present and past quality and quantity of smoking. RESULTS: There was a significant dose-effect relationship between the exposure to tobacco smoke and the extent of periodontal disease assessed as attachment loss and tooth loss. Moreover, there was a gene-environmental interaction. Subjects bearing at least one copy of the variant allele 2 at positions IL-1A -889 and IL-1B +3954 (genotype positive) had an enhanced smoking-associated periodontitis risk as compared to their IL-1 genotype-negative counterparts. With genotype-negative non-smokers as a reference, logistic regression resulted in odds ratios of 0.98 (95% confidence interval: 0.83 to 1.14), 2.37 (1.96 to 2.87), and 4.50 (2.30 to 8.82) for genotype-positive non-smokers, genotype-negative smokers, and genotype-positive smokers, respectively. CONCLUSIONS: There is a gene-environmental interaction between smoking and the IL-1 genetic polymorphism. Smokers bearing the genotype-positive IL-1 allele combination have an increased risk of periodontitis. The IL-1 genotype has no influence in non-smokers.

Adult↗
PubMed1991

Localised palatal tooth surface loss and its treatment with porcelain laminates.

Localised tooth surface loss and subsequent caries in a young patient due to an unusual dietary habit is reported. The treatment and management of such conditions is discussed. Tooth surface loss is a condition seen with increasing frequency, often associated with the retention of the natural dentition into older age. In these older patients, abrasion and attrition tend to predominate as the causative factors but, in younger patients, acid erosion is frequently implicated. The acid involved may be dietary, in the form of carbonated beverages, fruit juices, vinegar or excessive intake of citrus fruits. If not derived from the diet, gastric acid may be the source if the patient has gastric reflux, perhaps associated with an ulcer or, in cases of anorexia nervosa or bulimia, where the patient deliberately induces vomiting and bathes the teeth in acid. There is a preponderance of female patients in the latter categories, although not exclusively so. Sometimes patients develop habits where an acidic substance is held in contact with certain teeth and the erosive process is more localised. This is illustrated in the case quoted by Reuter where grapefruit was held against the palatal surfaces of the upper anterior teeth resulting in enamel loss affecting that area. In all these cases of erosion the affected tooth surface was reported as being hard and shiny, lacking any of the features normally associated with dental caries.(ABSTRACT TRUNCATED AT 250 WORDS)

Bicuspid↗
PubMed2000

The long-term management of patients with tooth surface loss treated using removable appliances.

The causes of tooth surface loss are multi-factorial and hence can be difficult to eradicate. This paper identifies the problems that may be anticipated during the long-term management of patients where tooth surface loss has been treated using removable appliances, where the number of teeth is often reduced. Wear and tear are inevitable and patients should therefore be made fully aware of the possibility of the gradual deterioration and failure of restorative work. Treatments should be planned, which would enable the dentist to recover the situation, with minimal inconvenience to the patient.

Dental Restoration, Permanent↗
PubMed2006

Compliance as a prognostic indicator: retrospective study of 505 patients treated and maintained for 15 years.

BACKGROUND: The relationship of patient compliance to overall tooth prognosis remains controversial. There are little data, often conflicting, that pertain to tooth loss as a function of patient compliance. METHODS: This retrospective study evaluates the impact of compliance (complete versus erratic) on common periodontal clinical variables, such as probing depth, bleeding index, plaque index, and tooth loss for 505 patients in a long-term period of observation (15 to 23 years) and maintenance therapy (at least 10 years). Compliance was defined in two ways for all analyses. Under the definition for compliance 1, patients who missed <30% of all prescribed maintenance visits were classified as complete compliers. Under the definition for compliance 2, patients who never went 2 years without a maintenance visit were classified as complete compliers. Change in clinical variables was dichotomized into reduction in plaque index versus no reduction, reduction in bleeding on probing versus no reduction, reduction in the percentage of periodontal pockets>3 mm versus no reduction, no increase in decayed, missing, or filled teeth (DMFT) versus increase, and no tooth loss versus tooth loss. The effects of both definitions of compliance were then evaluated in a series of multiple logistic regression models with adjustment for potential confounders. RESULTS: The analysis of the dichotomous change in clinical parameters over time revealed that complete compliers tended to show reduction in bleeding on probing and reduction in plaque index compared to erratic compliers for both definitions of compliance. In contrast, complete compliers under compliance 2 were less likely to have a reduction in the percentage of periodontal pockets >3 mm compared to erratic compliers, whereas complete compliers under compliance 1 had about the same likelihood of demonstrating a reduction in periodontal pockets compared to erratic compliers under this classification scheme. Under both definitions for compliance, complete compliers were more likely to exhibit tooth loss than erratic compliers, with the greatest tooth loss exhibited by complete compliers under the definition for compliance 1. CONCLUSIONS: Based on these results, complete compliers under both definitions tended to show a reduction in plaque and bleeding on probing over time. However, change in periodontal pockets and DMFT over time varied according to the definition of compliance that was used. In addition, the results seem to indicate that the decision for tooth extraction made by dental health professionals at maintenance visits may result in greater tooth loss.

Adult↗
PubMed2006

Tooth surface loss in adult subjects attending a university dental clinic in Trinidad.

OBJECTIVES: To determine the prevalence of tooth surface loss (TSL) in a sample of subjects attending a university dental clinic in Trinidad and to investigate the relationship to tooth brushing, medical history, parafunction and dietary habits. DESIGN: Tooth surface loss was measured clinically by the index used in the 1998 UK, Adult Dental Health Survey. SETTING: Trinidad, West Indies. PARTICIPANTS: Convenience sample of adult subjects attending The University of the West Indies Dental School Polyclinic, Mount Hope. METHODS: A questionnaire was administered and tooth surface loss measured clinically. MAIN OUTCOME MEASURES: mild, moderate and severe tooth surface loss. RESULTS: 155 subjects were examined (mean age 40.6 years) of whom 72% had some degree of TSL with the majority (52%), exhibiting mild, 16% with moderate and 4% with severe TSL. There were associations found between TSL and age (OR=3.14), reflux (OR=1.37), parafunction (OR=1.06), weekly consumption of citrus fruits (OR=1.31) and soft drinks (OR=1.78), daily consumption of alcohol (OR=1.40) and a vegetarian diet (OR=2.79). CONCLUSIONS: Tooth surface loss in this Trinidadian population group appears to be common. Data supports an association between TSL and age, reflux parafunction and certain dietary patterns.

Adolescent↗
PubMed1979

Untreated periodontal disease: a longitudinal study.

Thirty diagnosed but untreated patients with moderate to advanced periodontal disease were examined a minimum of two times. The examination time intervals ranged between 18 and 115 months. 2. A total of 83 teeth were lost between examinations. 3. Excluding a patient who lost 25 teeth, a total of 58 teeth were lost. The adjusted tooth loss was 0.61 tooth per patient per year (or 0.36 with the elimination of 22 "hopeless" teeth). 4. The mandibular and maxillary molars had the greatest percentage of tooth loss between examinations. 5. All 29 patients completing the study had progessive increases in pocket depth during their time in the study. Increases in the mean annual pocket depths per tooth per patient varied from 0.24 millimeter per year to 2.46 millimeters per year. 6. The disto-lingual and mesio-lingual interproximal surfaces had the greatest increases in surface pocket depths. The lingual and buccal surfaces had the smallest increases in pocket depth. 7. The rate of increase in pocket depths was less in patients over 44 years of age. 8. The teeth which were lost had greater initial pocket depths and mobility scores than those which were present at both examinations. 9. There was no correlation between increases in pocket depth and changes in mobility. 10. All 29 patients showed radiographic evidence of progressive bone resorption between examinations. The posterior segments of the mouth had the largest amounts of bone loss between the first and last examinations.

Adult↗
PubMed1992

Tooth surface loss and associated factors among factory workers in Finland and Tanzania.

The relative importance of various factors in the occurrence of tooth surface loss was explored in a, cross-sectional study using blind dental examinations. Two samples were drawn; one from Finland, comprising 186 workers from four factories and another from Tanzania of 180 workers from two factories. Among the 326 dentate individuals who participated, 164 were exposed to acid fumes and 162 were not. In Finland, people with tooth surface loss were older and smoked cigarettes less frequently. In Tanzania, those with tooth surface loss were also older and the proportion of subjects with the condition was significantly higher among people not using a commercial toothbrush and those exposed to acids. Among the Tanzanians, exposure to acids increased the probability of tooth surface loss to a high level of significance, and increasing age increased its probability, both among the Finns and the Tanzanians. Both anterior and posterior teeth were affected. It can be concluded that if the exposure to acids from the air breathed is high, the probability of tooth surface loss will increase. It seems that explanatory factors for tooth surface loss from one society cannot be extrapolated to another.

Adult↗
PubMed1995

Time required to remove totally bonded tooth-colored posterior restorations and related tooth substance loss.

OBJECTIVES: The study was conducted to measure the time required to remove large totally bonded tooth-colored posterior restorations and related tooth substance loss. This information was collected to determine if there were differences between bonded restorations and conventional restorations. METHODS: Molars were restored with the following materials: amalgam, composite, glass ionomer cement or glass ceramic cusp coverages. After submitting them to an in vitro aging process, they were attached to a lower jaw model in a phantom head. Six dentists removed the test restorations under standardized, quasi-clinical conditions. RESULTS: While the amalgam was completely removed, some glass ionomer cement vestiges were found. In the glass-ceramic group, the margins were covered with remnants of the composite luting agent in several places. The most restorative material was left in the composite group. The loss of tooth structure after removal of amalgam, glass ionomer cement, composite and glass ceramic was 17.6 mm3, 19.6 mm3, 39.9 mm3 and 41.8 mm3, respectively. When comparing the removal time, the glass ionomer group scored best with an average of 11.9 min followed by the amalgam group with an average of 15.2 min, followed by 24.9 min for the composite group and 30.4 min for the glass ceramic group. SIGNIFICANCE: The removal of totally bonded posterior restorations made of composite and ceramic is more technically demanding and more time-consuming than the removal of glass ionomer and amalgam restorations.

Acrylic Resins↗
PubMed1996

Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival.

Tooth loss for 100 treated periodontal patients (2,509 teeth) under maintenance care was evaluated to determine the effectiveness of commonly taught clinical parameters utilized in the assignment of prognosis in accurately predicting tooth survival. Previous studies in this series evaluated prognosis as a surrogate variable representing the condition of the tooth at a particular point. In this study, survival analysis was used to evaluate the relationship of these common clinical parameters to an actual end point, tooth loss. Robust log rank tests indicated that initial probing depth, initial furcation involvement, initial mobility, initial crown-to-root ratio, and initial root form were all associated with tooth loss. In addition, smoking and increased initial bone loss were both found to be associated with increased risk of tooth loss while fixed abutment status was associated with a decreased risk of tooth loss. A Cox proportional hazards regression model showed that initial probing depth, initial furcation involvement, initial mobility, initial percent bone loss, presence of a parafunctional habit without a biteguard, and smoking were all associated with an increased risk of tooth loss. This model suggests that patients are twice as likely to loose their teeth if there is increasing mobility, if they have a parafunctional habit and do not wear a biteguard, or if they smoke. From these data there does appear to be a relationship between the assigned prognosis and tooth loss. Teeth with worse prognosis have a worse survival rate, but the commonly taught clinical parameters used in the traditional method of assignment of prognosis do not adequately explain that relationship. Furthermore, initial prognosis did not adequately explain the condition of the tooth or accurately predict the tooth's survival. These results seem to indicate that the effect of these clinical parameters on tooth survival is only partially reflected in the assigned prognosis initially, suggesting that perhaps some of the clinical parameters should be weighed more heavily than others when assigning prognosis. Further studies are needed to develop a more accurate method for the assignment of prognosis.

Alveolar Bone Loss↗
PubMed2003

Oral health and peripheral arterial disease.

BACKGROUND: Many studies have reported the association between poor oral health and coronary heart disease or stroke, but few of them evaluated peripheral arterial disease (PAD). Hence, in this study we examined the associations between oral health and PAD. METHODS AND RESULTS: In the prospective study of 45,136 eligible male health professionals free of cardiovascular diseases at baseline, we identified 342 cases of PAD during a 12-year follow-up period. We evaluated the association between different measures of oral diseases and the occurrence of PAD. Baseline number of teeth was not related to the risk of PAD, but cumulative incident tooth loss was significantly associated with elevated risk of subsequent occurrence of PAD. The relative risk for history of periodontal disease was 1.41 (95% CI, 1.12 to 1.77) and for any tooth loss during the follow-up period was 1.39 (95% CI, 1.07 to 1.82), controlling for traditional risk factors of cardiovascular disease. Among men with a history of periodontal diseases, the relative risk of tooth loss increased to 1.88 (95% CI, 1.27 to 2.77), whereas no association was found between tooth loss and PAD among those without periodontal diseases (RR, 0.92; 95% CI, 0.61 to 1.38). We further explored the potential induction period of tooth loss and found that tooth loss in the previous 2 to 6 years was most strongly associated with PAD. CONCLUSIONS: We found that incident tooth loss was significantly associated with PAD, especially among men with periodontal diseases. The results support a potential oral infection-inflammation pathway.

Adult↗
PubMed1999

Prognosis versus actual outcome. IV. The effectiveness of clinical parameters and IL-1 genotype in accurately predicting prognoses and tooth survival.

BACKGROUND: Recently, a genetic marker (IL-1 genotype) that identifies individuals at higher risk for developing severe periodontal disease was discovered. A subgroup of the population reported on earlier was evaluated to determine if knowledge of the patient's IL-1 genotype would improve accuracy in assignment of prognoses and prediction of tooth loss. METHODS: This subgroup consisted of 42 patients (1,044 teeth) in maintenance care for 14 years; 16 tested IL-1 genotype-positive (IL-1GP). Nine were smokers, and 30 had a history of smoking, with an average of 29.44 pack years. A multiple Cox regression model and Kaplan-Meier survival plots were fit to the subset of patients to evaluate tooth loss. RESULTS: Both IL-1GP and heavy smoking were significantly related to tooth loss. A positive IL-1 genotype increased the risk of tooth loss by 2.7 times, and heavy smoking by 2.9 times. The combined effect of IL-1GP and heavy smoking increased the risk of tooth loss by 7.7 times. The value of clinical parameters traditionally used to assign prognosis was found to be dependent on IL-genotype and smoking status. In the model that included IL-1 genotype and heavy smoking, none of the clinical parameters added significantly to the model for tooth loss while mobility, probing depth, crown-to-root ratio, and percent bone loss added significantly to the model, which included IL-1 genotype in non-smokers. IL-1GP patients and patients who smoked heavily demonstrated a much worse tooth survival rate when compared to IL-1 genotype-negative patients and non-smokers, respectively. CONCLUSIONS: Knowledge of the patient's IL-1 genotype and smoking status will improve the clinician's ability to accurately assign prognosis and predict tooth survival. Clinical implications are as follows. Investigators were unable to judge which patients would be IL-GP or negative based on their clinical presentation or family history of tooth loss due to periodontal disease. Since periodontal diseases are multifactorial, knowledge of the patient's genotype is more important in predicting future risk than explaining past disease. Knowledge of IL-1 genotype status would be important in developing a treatment plan and predicting tooth survival for a new patient who smokes and presents with periodontal disease, especially if restorative care is needed. Knowledge of a maintenance patient's IL-1 status would help target therapy for non-responding areas; one would be less likely to take a "wait and see approach" with IL-1GP patients. IL-1 positive non-smokers can be successfully treated and maintained over long periods of time.

Adult↗
PubMed1998

Estrogen replacement therapy--something to smile about.

Tooth loss and alveolar residual ridge resorption are significant oral health problems in older adults. Although the causes of tooth loss are many, several studies show an association between tooth loss/residual resorption and systemic osteoporosis. Because estrogen replacement therapy (ERT) slows the development of osteoporosis, we investigated the relationship between estrogen use and tooth loss among elderly women who were participating in the Leisure World Cohort Study. Among 3,921 women 52 to 109 years old (median = 81), those who had ever used estrogen retained more teeth than nonusers (21.2 vs 19.2). The age-adjusted risk of having fewer than 25 teeth decreased with increasing duration of ERT: 0.87 for < 4 years of ERT, 0.74 for 4 to 14 years, and 0.70 for 15+ years compared to nonusers. Similarly, the risk of edentia was inversely related to estrogen use. If a woman had ever taken ERT, her risk of losing all her teeth was about two thirds that of a woman who had never used estrogen. Long-term users (15+ years) had half the risk of becoming toothless. Despite differences in age, education, methods of obtaining tooth and hormone data, and prevalence of tooth loss, two other cohort studies (the Nurses' Health Study and the Framingham Heart Study) reported similar reductions in tooth loss among estrogen users. The data suggest that tooth retention, in addition to being affected by osteoporosis of alveolar bone, also shares in the benefits of ERT on osteoporosis.

Age Factors↗
PubMed1999

[Etiology of missing teeth].

This article gives a brief overview of the causes of tooth loss. Caries is still the most prominent reason for tooth loss. In patients over 40 years, periodontal reasons become more prevalent. However, also in this age category caries is the main reason. In young individuals, missing teeth are most frequently associated with agenesia or trauma. Iatrogenic damage is considered to be a casuistic cause of tooth loss. Nevertheless, some specific areas, such as in the combined treatment 'endodontic treatment--post and core--crown', can be distinguished in which tooth loss is more frequently seen.

Age Factors↗
PubMed1991

[Conventional surgical furcation therapy. Closed and open scaling].

Epidemiological studies in the sixties indicated that in patients older than 45 years periodontal disease was the major cause of tooth-loss, particularly in molars. However, improved prevention and enhanced dental awareness have now reduced both the incidence of periodontal disease and tooth-loss. Unfortunately, periodontal disease and tooth-loss still progress rapidly in a small group of patients. The currently used diagnostic parameters do not allow the early identification of this small group. Despite controlled periodontal treatment, loss of molars has remained twice as high as overall tooth loss. When all patients are divided into different perio-subgroups, molar loss tends to identify patients with a high periodontal risk. This conclusion can be drawn from the fact that furcation treatment is usually clinically successful, although calculus removal is insufficient. Early diagnosis of molar furcation involvement may help identify the small group of patients in which periodontitis may develop. The local morphological patterns may also contribute to rapid progression of the disease resulting eventually in loss of the molars. In such cases resective therapy is proposed instead of the usual open or closed scaling procedures.

Adult↗
PubMed2003

An investigation of the relationship between systemic bone density and clinical periodontal status in post-menopausal Asian-American women.

OBJECTIVES: The relationship between osteoporosis and periodontal disease is not understood. The aim of this study was to examine the association between bone mineral density (BMD) and periodontal status in a population of Asian-American women. DESIGN: Cross-sectional investigation of the association between systemic BMD and periodontal status. PARTICIPANTS: Thirty post-menopausal, dentate, Asian-American women who were screened for osteoporosis and chronic periodontitis. METHODS: BMD of the os calcis, composed primarily of trabecular bone, was assessed by DEXA scanning. Periodontal assessments included tooth loss, plaque index, probing depths, and clinical attachment levels. Correlation and regression analyses were conducted to determine the strength of associations between BMD and clinical parameters. RESULTS: Statistically significant negative correlations were found between BMD and tooth loss and BMD and clinical attachment loss (p < 0.01). Those with normal BMD had lost, on average, 6.8 teeth, compared to 10.5 teeth in the osteopenic group, and 16.5 teeth in the osteoporotic group (p < 0.001). CONCLUSIONS: Decreasing BMD was associated with increased clinical attachment loss and tooth loss that was independent of plaque scores. These data support an association between BMD and periodontal status.

Absorptiometry, Photon↗