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PubMed2006

Incipient caries lesions on cementum by mono- and co-culture oral bacteria.

OBJECTIVES: There is increasing prevalence of root caries. We hypothesized different biofilms will cause varying demineralization in cementum. This study investigated the extent of demineralization of cementum by oral biofilm formed from three major cariogenic microorganisms: Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces israelii. Sound cementum tooth blocks were incubated with mono-, bi-, and tri-species combinations of the bacteria under investigation. MATERIALS AND METHODS: The matrix (amide I) and phosphate content of the lesions was analyzed by Fourier-transform infrared spectroscopy (FTIR), and calcium and phosphorus levels were analyzed by scanning electron microscopy and energy-dispersive spectroscopy (SEM-EDX). RESULTS: The log[amide I:HPO(4)(2-) absorbance] values showed that A. israelii mono-culture caused significantly more demineralization than the other bacterial cultures. log[Ca:P] showed that all carious lesions were confined to the cementum. CONCLUSIONS: Oral biofilm arising from bacterial species A. israelii alone was the most cariogenic of those tested and produced the most demineralization in incipient carious lesions in cementum.

Actinomyces↗
PubMed1991

Prevalence and distribution of dental caries in a late medieval population in Finland.

The aim was to document the late medieval material and to compare the results with findings in other medieval populations and present-day Finns. The sample consisted of the remains of 410 individuals and included 4581 permanent and 600 deciduous teeth. Age determination was based on the stage of dental development and on the attrition pattern in the molar region. Scoring the presence and location of caries was done visually with the aid of a dental probe. In the younger age groups, caries was most prevalent in the occlusal fissures, but the proportion of cavities at these sites declined with age, possibly because occlusal attrition progressed more rapidly than did caries. In the permanent dentition, carious lesions were most frequently observed at the cementum-enamel junction, particularly on the approximal surfaces. The prevalence of caries was lower than among modern populations of similar ages. In addition, the relative distribution of caries was strikingly different, with root caries being the most common type.

Adolescent↗
PubMed1997

Developments in fluoride toothpastes--an overview.

OBJECTIVE: This paper reviews current issues in the development of fluoride toothpastes as a public health measure. DESIGN: The issues examined included low concentration formulations, delivery systems, dispensing instructions and labelling, oral clearance. effect on root caries, additional therapeutic agents and marketing and manufacturing issues. RESULTS: Lower fluoride formulations may carry a lower risk of fluorosis but this must be balanced against a higher risk of caries. Risk factors for fluorosis include inappropriate fluoride supplements but the age at which toothbrushing began, frequency of brushing and residence in an optimum fluoride area have also been implicated. CONCLUSIONS: The dental profession should: clarify the most appropriate fluoride concentration in toothpastes used for children; ensure that other sources of fluoride do not increase the risk of dental fluorosis: investigate the effectiveness of fluoride toothpaste in inhibiting root surface caries in adults. Manufacturers should: continue to improve the performance of fluoride toothpaste; ensure that all pastes maximise fluoride bioavailability; develop active agents to help reduce oral disease; label products clearly with ppm F; review the delivery systems so as to reduce the risk of dental fluorosis.

Adult↗
PubMed2003

Oral diseases and conditions in community-living older adults with and without dementia.

This study compared the prevalence and experiences of oral diseases and conditions, as well as tooth loss and retained root status, in community-dwelling older adults with and without dementia. Dental examinations were conducted at baseline and at one-year for randomly selected samples of 116 dentate community-living older adults with dementia and a comparable group of 116 adults without dementia. Participants with dementia had significantly higher experiences of oral diseases and conditions at baseline and one-year compared with participants without dementia: decreased use of dentures; increased prevalence of denture-related oral mucosal lesions; increased plaque accumulation; increased prevalence and experiences of coronal and root caries; and increased numbers of decayed retained tooth roots. These higher experiences of oral diseases and conditions were related to dementia severity, not to specific dementia diagnoses. Participants with dementia already had a compromised oral health status when admitted into institutional long-term care between baseline and one-year; of concern were the high plaque levels on the natural teeth of the group of institutionalized participants with dementia.

Aged↗
PubMedDate not supplied

Streptococcus mutans, lactobacilli, and caries experience in older adults.

This study investigated salivary levels of Streptococcus mutans, lactobacilli, and caries experience in a random sample of 448 black and 362 white older dentate adults living in North Carolina. Significant proportions of the participants had stimulated salivary flow rates less than 1.0 mL/min, salivary buffering capacity less than 4.0, S. mutans levels of 10(5) cfu/mL or more in stimulated whole saliva, or lactobacilli levels of 10(5) cfu/mL or more. Each of these factor levels could be considered, on a clinical basis, to increase caries risk. In general, people with higher levels of S. mutans or lactobacilli had more untreated coronal and root caries, but not greater total caries experience.

Aged↗
PubMed1998

Active and inactive caries lesions in a selected elderly institutionalised French population.

Various epidemiological investigations have shown the high prevalence and incidence of caries in geriatric populations. The aim of the present study was to evaluate the dental status and some salivary parameters of elderly French subjects institutionalised in a geriatric hospital. The study population included 117 subjects (31 males and 86 females) who were neither demented nor edentulous, with a mean age of 83.0 years (SD = 7.8). Crown and root caries were recorded according to a modified caries activity index on 17,442 surfaces (9 surfaces per tooth: 5 crown surfaces and 4 root surfaces). The 17,442 surfaces examined corresponded to 1,938 teeth. The mean number of teeth per subject was 16.6 (SD = 7.6), more teeth remaining in the mandible than in the maxilla. The 2,985 unsound root surfaces showed a high percentage of active lesions (31.2 per cent) and a low percentage of filled root surfaces (4.5 per cent). Crowns and roots also presented a high percentage of destroyed surfaces: 1,446 destroyed surfaces, 8.3 per cent of the examined surfaces. Salivary parameters (flow rate and buffer capacity) were also recorded. Stimulated salivary flow rate had a relationship with crown caries (linear regression and analysis of covariance), and buffer capacity with root caries (analysis of variance and covariance). The data illustrate critical treatment needs in French geriatric institutions. This situation, which appears to differ from previous reports in European and US elderly people, may be related to French specificities concerning oral health status and/or care policy, but also to the usually very old population.

Aged↗
PubMed1996

Caries prevalence in the dentition of a late eighteenth century population.

Remains of 92 individuals of known age and a further 71 of unknown age were selected from nearly 1000 skulls exhumed from the crypt of Christ Church, Spitalfields. Ante- and post-mortem tooth loss was assessed and caries prevalence and distribution were studied. Post-mortem loss of teeth was highest in the oldest age group, suggesting that greater care is needed during exhumation to minimize this loss. Juvenile caries levels were high, especially on occlusal surfaces of deciduous molars. Approximal caries was less frequently seen and buccal and lingual sites were only slightly less frequently involved than approximal sites. Root caries was rare, even in the oldest age group. There were differences in prevalence and distribution between males and females but not between those of English and French origins. Caries levels were generally higher in those born after 1750. It is suggested that factors other than diet and oral hygiene may have influenced caries prevalence in this population.

Age Factors↗
PubMed1994

Prevalence of dental caries among Ethiopian emmigrants.

Studies have documented the prevalence of caries in developing countries. The current study adds to this body of knowledge. Of the total Ethiopian Jewish population who emmigrated to Israel in 1991, a sample of over 800 individuals was randomly selected representing all age groups. DMF-T and DMF-S scores were recorded, as well as percentages of caries free individuals. Results indicated that almost no fillings or crowns had been provided to the study population. The Missing 'M' component was low as was the Decay 'D' component, although this increased with increasing age, ranging from 0.33 D-T at the 0-12 age group to 2.46 at the 51+ age group. In the permanent dentition 88.4 per cent of those 0-12 years of age were caries free and 74.5 per cent were caries free in both the primary and permanent dentition. Almost 59 per cent of the 13-20 years olds were caries free and 32.8 per cent of those 21-50 years old. Only 16.7 per cent were caries free at age 51+ years old. The data indicate a relatively low prevalence of both coronal and root caries, and an effort has to be made to keep these figures low for years to come mainly by diet and dental health education.

Adolescent↗
PubMed2000

Caries preventive knowledge and practices among dental hygienists.

PURPOSE: The aim of this study was to determine the knowledge, opinions, and practices of dental hygienists in the areas of dental caries etiology and prevention. METHODS: A pretested, validated 35-question survey instrument was mailed to a one percent national, stratified random sample of dental hygienists in the United States (n = 960) in October 1996. Four complete mailings of the instrument resulted in a 67% response rate, of which 77% were useable (n = 498). Respondents were asked if they agreed or disagreed with statements on caries etiology and preventive procedures, and also asked to rate the effectiveness of procedures for preventing dental caries in children and adults. Data were analyzed using descriptive statistics, t-tests, and ANOVA. RESULTS: Overall level of knowledge of caries etiology and preventive procedures was low. More than 40% of subjects did not recognize that remineralization is the most important mechanism of action of fluoride, and fewer than 50% recognized that dental caries is a chronic infectious disease. Analysis of four factors thought to be related to knowledge and practice showed that younger graduates, more recent graduates, and ADHA members were more knowledgeable about the effectiveness of caries preventive procedures for children (p < .01). Although an overwhelming majority correctly agreed that adults benefit from fluoride and that root caries is an emerging problem, this knowledge was inconsistent with practice (p = .02). Fewer than 35% reported that they provide fluoride to adults of any age, or they wait until the disease is present. For children and adults who did receive fluoride treatments, a one-minute application of an APF gel or foam was most often provided. CONCLUSIONS: Correct information about the etiology and prevention of dental caries is a predisposing factor to making informed decisions. Overall, respondents overrated the effectiveness of flossing and toothbrushing while underrating the effectiveness of fluorides. In the majority of cases, efficiency rather than efficacy was given priority when providing a topical fluoride treatment. An improved understanding of dental caries etiology and the scientific evidence for appropriate caries preventive procedures will allow dental hygienists to prevent and manage this disease better.

Acidulated Phosphate Fluoride↗
PubMed1998

[Clinical considerations apropos of topical fluorides in the control of dental caries].

Studies on the caries reducing effect of topical fluorides have provided a great understanding of their therapeutic role in caries control. It is believed that topically applied fluorides interfere with dental tissue demineralisation and reduce the rate of caries progression. According to this assumption, topical fluorides are recommended to both children and adults as a measure to control coronal as well as root caries. In the present review, some aspects of caries development and arrest are considered and the reasoning behind topical fluoride application is discussed. Guidelines concerning self-applied and professionally applied topical fluorides regimes according to the patient's caries risk and caries activity are presented.

Adult↗
PubMed2005

Dental caries in older adults.

Dental caries is one of the most significant health problems facing older adults. More than half of the elderly who are dentate are affected with either coronal or root caries, and caries is the primary cause of tooth loss in this population. New materials and techniques are emerging to help with geriatric preventive and restorative needs, but ongoing vigilance for caries will be required in this population, which is experiencing increased longevity and tooth retention.

Aged↗
PubMed1997

Diagnostic tools and measurements--impact on appropriate care.

The diagnosis of primary coronal caries should be seen as a complex process, comprising both detection and measurement phases, which enables clinicians, researchers and epidemiologists to make informed decisions about the management and prognosis of the disease process. The different diagnostic thresholds employed for measurements of caries experience can be viewed as an iceberg, a metaphor which demonstrates the ambiguity of the term "caries free" and which can also represent the differing management options appropriate for the care of different types of active and inactive lesions: NAC (No Active Care). PCA (Preventive Care Advised) and OCA (Operative Care Advised). There are considerable methodological difficulties in drawing valid comparisons between studies using incompatible criteria and simulations. However, it is apparent that no caries diagnostic tool in current clinical use fulfils all of the ideal criteria for measurements needed to plan and monitor appropriate care. Systems providing reliable serial measurements with which to assess future caries risk and present caries activity are urgently required as diagnostic tasks are becoming both more difficult and more important from the standpoint of long-term oral health. Existing diagnostic tools frequently rely on subjective judgements and provide only semi-quantitative measures insensitive to smaller lesions. In the future tools are needed which are objective, quantitative and which can provide acceptable compromises between sensitivity and specificity for a wide range of applications for individual patient care as well as for research and survey use. Key problem areas with existing tools include confusion in terminology and between caries assessments made by clinicians and epidemiologists as well as the lack of valid measurements relating to the activity of primary root caries and secondary caries. Deficiencies with current tools impact on the care of individuals by allowing false negative diagnoses of hidden occlusal dentine lesions and approximal cavities on the one hand, whilst generating some false positive diagnoses on sound surfaces leading to inappropriate decisions to restore on the other. At the population level, current conventional tools significantly underestimate overall caries experience. In future the adoption of more accurate and reliable methods would facilitate more effective preventive care and promote more appropriate restorative treatment decisions. Research in this area should focus for the next five years on diagnostic technologies which: 1) inform valid prospective caries risk assessments for different age groups, 2) can help to determine present caries activity and monitor lesion behaviour over time and 3) help identify methods which can implement existing and new research knowledge about diagnostic tools into clinical and research practice.

Age Factors↗
PubMed1993

Assessment of the clinical status of primary root carious lesions using an enzymic assay.

The microflora of root carious lesions (n = 151) and sound root surfaces (n = 30) in 22 institutionalized, older patients was investigated using a standardized method of sampling. Material was removed using a sterile excavator and the numbers of bacteria in each sample were determined using conventional culturing techniques and by rapid (2 h) fluorogenic enzyme assay. Correlation between bacterial counts and enzyme assay result was 0.873 (p < 0.001). The numbers of bacteria and fluorogenic enzyme assay values were significantly (p < 0.001) greater from soft lesions than from leathery lesions while hard lesions and sound root surfaces had significantly (p < 0.001) lower values than the other lesion types and were not different from each other. A similar trend was apparent when these values were correlated with treatment needs. The fluorogenic enzyme assay may provide a rapid, objective measure of root caries severity which might be used in the monitoring and comparison of treatment protocols.

Aged↗
PubMed2001

Caries-preventive effects of fluoride products when used in conjunction with fluoride dentifrice.

Toothbrushing with fluoride dentifrice has become an important public health measure in preventing caries and gingivitis. Since the fluoride concentration in dentifrices does not provide absolute protection for everyone and is limited by legal regulations, the question about the efficacy of additional use of topical fluoride products arises. In children aged 9-15 years, the biannual application of Duraphat varnish in school-based programmes provides a caries inhibition of 38%. A caries inhibition of up to 40% can also be achieved by gels containing 1.25% fluoride, if applied 30 times per year. In subjects with a risk of root caries, the daily use of a 250-500 ppm fluoride solution seems to be advisable.

Adolescent↗
PubMed1996

Intra-alveolar transplantation. I. A 10-year follow-up of a method for surgical extrusion of root fractured teeth.

A group of 19 patients where traumatic root fractures were treated with surgical extrusion procedure has been clinically and radiographically followed up for 10 years. Except for one out of 21 intraalveolar transplanted roots all functioned with different kinds of crown restorations and without pathological complications. The surgical extrusion method should thus be a useful tool in the treatment of teeth with cervical root-fractures and also teeth with deep cervical root caries which are difficult to treat conservatively.

Adult↗
PubMed1999

Dental treatment of patients with neurodegenerative disease.

Neurodegenerative disorders are among the most challenging and devastating illnesses in medicine. A heterogeneous group of chronic and progressive diseases, they include Alzheimer's, Parkinson's, and Huntington's diseases. Dentists faced with patients affected by one of these disorders are confronted with the major problems of cognition, mobility, and behaviour, as well as of dental maintenance. While treatment of patients with progressive neurodegeneration remains daunting, increased knowledge of the aetiology and pathogenesis of these diseases has provided new opportunities and a new understanding of their treatment needs. In this article, we briefly describe the effects of ageing on the brain, and introduce two of the major neurodegenerative disorders, Alzheimer's and Parkinson's diseases. The dental problems associated with these conditions include a decrease in oral hygiene, difficulty in controlling and retaining dentures, and purposeless chewing. Medications can result in xerostomia and consequent root caries and recurrent decay. Where possible, individuals with neurodegenerative disorders should always be treated by the same dentist.

Aging↗
PubMed2002

Dental caries: risk assessment and treatment solutions for an elderly population.

Caries remains one of the top three most common infectious diseases in the world today. Although caries prevalence decreased markedly in children and in adults up to age 40 between 1975 and 2000, the overall risk for caries in older age groups (45 to 64, 65 to 84, and > 85 years of age) has not decreased appreciably. In fact, the risk for caries in individuals 70 years of age and older has increased. The increase in restorative work needed between 1990 and 2030 will be highest in adults over the age of 44 years. Root caries prevalence and the number of restored teeth will be greatest in the elderly population. Approximately 30% of individuals over the age of 65 will have no permanent teeth. It is also apparent that additional caries risk factors are associated with a significant proportion of the older population, including reduced saliva flow, inadequate oral hygiene, frequent sugar intake, Asian ethnicity, and the presence of partial dentures. The principles of modern caries management focus on risk assessment, risk reduction, monitoring noncavitated carious lesions, and the assignment of specific treatment options according to risk. Because a relatively high proportion of elderly patients will remain at high risk for caries, therapeutic regimens for managing caries as an infectious disease must focus on the use of antibacterial treatment; high-fluoride dentifrices; supplementary low-dose, high-frequency fluoride rinses; patient education; and shorter recall intervals.

Adolescent↗
PubMed2002

Dental screening of older adults living in residential aged care facilities in Perth.

BACKGROUND: This study aimed to estimate the dental treatment needs and oral health status of a sample of older adults in residential aged care facilities in Perth. METHODS: The 348 participants (> or = 65 years) were interviewed and screened in 25 facilities. The screenings were carried out by one examiner using a mirror and a portable light. RESULTS: Over half (52 per cent) of the participants were edentulous and 45 per cent of those edentulous participants for whom a recording was made (n=174) had oral mucosal conditions. The 164 dentate participants had a mean of 12 disease-free standing teeth, a mean decayed, missing or filled teeth (DMFT) of 24.7 (mean DT 0.8, mean FT 5.3) and half of them required the removal of supragingival calculus. Of those with root caries experience (n=127), a mean of 1.3 untreated decayed roots and a mean of 1.9 roots covered in plaque were recorded. The majority of the participants (83 per cent) were pensioners eligible for government subsidized dental care and 47 per cent were reported by the Directors of Nursing to have dementia. CONCLUSIONS: The data collected here demonstrate poor oral health conditions and a substantial treatment need in a neglected population. More people in nursing homes and hostels are keeping their natural teeth compared with a similar population studied 13 years ago.

Aged↗