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[Age assessment at the time of death based on panoramic radiography].

BACKGROUND: The determination of age at the time of death is an important method in forensic anthropology and paleodemography. The possible postmortem investigation of the teeth and jaws enables the determination of age at the time of death, as the bones and teeth are both resistant to degradation in soil and characterized by age-related morphological changes. The aim of this study was to determine whether the age-related changes visible on panoramic radiography correlated with age, and enabled the assessment of individual age. METHODS: Seven radiographic parameters were used in the study: tooth loss, occlusal tooth wear, pulp stones, carious teeth, periapical disease, tooth restoration, and alveolar bone loss associated with periodontal disease. RESULTS: The material comprised 314 dental panoramic tomograms of living patients of both sexes with documented age (18 to 77 years). Multiple regression equations were constructed for the age estimation, including four parameters (the number of missing teeth, the number of intact teeth, the distance of cement-enamel junction from the alveolar ridge, the number of abraded teeth). The nature of data treated by regression analysis required the careful choice of parameters, appropriate functional model for each parameter, and the experience of the investigator. With the four parameters included in equations, the error was +/- 2.55 years. CONCLUSION: This preliminary analysis showed that the conventional regression technique could be appropriate for the age estimation based on panoramic radiography, and that an additional study with a larger sample and on wider population was required.

Adolescent↗

Periodontal diseases and osteoporosis: association and mechanisms.

There is increasing evidence that osteoporosis, and the underlying loss of bone mass characteristic of this disease, is associated with periodontal disease and tooth loss. Periodontitis has long been defined as an infection-mediated destruction of the alveolar bone and soft tissue attachment to the tooth, responsible for most tooth loss in adult populations. Current evidence including several prospective studies supports an association of osteoporosis with the onset and progression of periodontal disease in humans. The majority of studies have shown low bone mass to be independently associated with loss of alveolar crestal height and tooth loss. However studies that focus on the relation of clinical attachment loss and osteoporosis are less consistent. To date, the majority of studies on the relationship between periodontal disease and osteoporosis have been hindered by small sample sizes, limited control of other potential confounding factors, varying definitions of both periodontal disease and osteoporosis, and few prospective studies where the temporality of the association can be established. Potential mechanisms by which host factors may influence onset and progression of periodontal disease directly or indirectly include underlying low bone density in the oral cavity, bone loss as an inflammatory response to infection, genetic susceptibility, and shared exposure to risk factors. Systemic loss of bone density in osteoporosis, including that of the oral cavity, may provide a host system that is increasingly susceptible to infectious destruction of periodontal tissue. Studies have provided evidence that hormones, heredity, and other host factors influence periodontal disease incidence and severity. Both periodontal disease and osteoporosis are serious public-health concerns in the United States. Prevalence of both osteoporosis and tooth loss increase with advancing age in both women and men. Understanding the association between these common diseases and the mechanisms underlying those associations will aid health professionals to provide improved means to prevent, diagnose, and treat these very common diseases. This paper reviews the current evidence on the association between periodontal disease and osteoporosis.

Adult↗

Dental caries. Principal cause of tooth extraction in a sample of US male adults.

Comprehensive oral examinations carried out over a period of about 10 years on participants in the Veterans Administration Dental Longitudinal Study were evaluated to identify teeth extracted during this time and to ascertain the apparent reason for these extractions. The study population included 736 dentulous adult males, 49% of whom experienced 1,142 extractions. Caries was judged to be the primary cause of tooth loss, responsible for 33.3% of the teeth extracted. Extractions in preparation for a prosthesis (31.3%) and periodontal disease (18.7%) were the other major causes of tooth loss. Thus, dental caries was the prime cause of tooth extraction in this sample of US male adults, while a second major cause was preparation for a prosthesis which included the extraction of sound teeth and teeth with carious lesions which could have been restored. Periodontal disease was clearly not the major cause of tooth loss and was responsible for only 18.7% of the extractions in this population. The results of this study demonstrate that dental caries is a major problem in adults, leading to greater tooth loss than periodontal disease. A large percentage of the tooth loss in these individuals was clearly preventable. The same emphasis placed upon caries prevention in children should be applied to the adult population.

Adult↗

Management of tooth surface loss.

This part of the series is devoted to tooth surface loss (TSL) not caused by caries or trauma. The management of this form of generalised TSL is included in this series because knowledge of occlusion is needed for both the diagnosis and, when indicated, treatment. There are, however, many other factors involved in the management of generalised TSL other than those associated with 'occlusion'. These will also be discussed.

Bruxism↗

Loss of tooth structure associated with chronic regurgitation and vomiting.

In summary, a teenaged patient had generalized loss of tooth structure. As the patient previously had a normal dental history and as his family history was negative, many causative factors were quickly ruled out. Finally, after obtaining full cooperation of the patient and reviewing the complete medical records, it was concluded that the loss of tooth structure resulted from demineralization by acidic gastric contents, due to chronic regurgitation and vomiting.

Adolescent↗

A review of the oral health of American Indian and Alaska Native elders.

OBJECTIVES: This paper reviews the demographics, access to care barriers, and the oral health of American Indian and Alaska Native (Native American) elders aged 65 years and older using complete tooth loss as a measure to compare with the US population. Strategies for improving oral health and increasing access to care for Native American elders also are discussed. METHODS: We reviewed the results from patient surveys conducted by the Indian Health Service (1983-84 and 1991) and data from other sources, including the second International Collaborative Study of Oral Health Outcomes (ICS-II) conducted in 1990 on the Sioux and Navajo reservations. We compared complete tooth loss data from these studies with findings of the 1985 National Institute of Dental Research Oral Health Survey of US Employed Adults and Seniors and the Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: The 1991 Indian Health Service (IHS) patient survey reported a complete tooth loss prevalence of 42 percent among elders. Although it is based on a patient sample, this finding is comparable to the rate of 40 percent found among a random sample of Navajo and Lakota adults aged 65-74 years reported in the ICS-II study. The 1991 IHS patient survey also found complete tooth loss among diabetics to be much higher than among nondiabetics. CONCLUSIONS: The prevalence of complete tooth loss for Native American elders is higher than in population surveys of US elders based on random samples. The actual prevalence of complete tooth loss is probably even higher in Native American elders because estimates presented in this paper are clinic based.

Aged↗

Tobacco smoking and chronic destructive periodontal disease.

Tobacco smoking is the main risk factor associated with chronic destructive periodontal disease. No other known factor can match the strength of smoking in causing harm to the periodontium. The harmful effects manifest themselves by interfering with vascular and immunologic reactions, as well as by undermining the supportive functions of the periodontal tissues. The typical characteristic of smoking-associated periodontal disease is the destruction of the supporting tissues of the teeth, with the ensuing clinical symptoms of bone loss, attachment loss, pocket formation, and eventually tooth loss. A review of the international literature that has accumulated over the past 20 years offers convincing evidence that smokers exhibit greater bone loss and attachment loss, as well as more pronounced frequencies of periodontal pockets, than non-smokers do. In addition, tooth loss is more extensive in smokers. Smoking, thus, considerably increases the risk for destructive periodontal disease. Depending on the definition of disease and the exposure to smoking, the risk is 5- to 20-fold elevated for a smoker compared to a never-smoker. For a smoker exposed to heavy long-life smoking, the risk of attracting destructive periodontal disease is equivalent to that of attracting lung cancer. The outcome of periodontal treatment is less favorable or even unfavorable in smokers. Although long-term studies are rare, available studies unanimously agree that treatment failures and relapse of disease are predominantly seen in smokers. This contention is valid irrespective of treatment modality, suggesting that smoking will interfere with an expected normal outcome following commonplace periodontal therapies. The majority of available studies agree that the subgingival microflora of smokers and non-smokers are no different given other conditions. As a consequence, the elevated morbidity in smokers does not depend on particular microflora. The mechanisms behind the destructive effects of smoking on the periodontal tissues, however, are not well understood. It has been speculated that interference with vascular and inflammatory phenomena may be one potential mechanism. Nicotine and carbon monoxide in tobacco smoke negatively influence wound healing. Smoking research over the past two decades has brought new knowledge into the domains of periodontology. Even more so, it has called into question the prevailing paradigm that the disease is primarily related to intraoral factors such as supra- and subgingival infection. Smoking research has revealed that environmental and lifestyle factors are involved in the onset and progression of the disease. Being the result of smoking, destructive periodontal disease shares a common feature with some 40 other diseases or disorders. As a consequence, periodontal disease should be regarded as a systemic disease in the same way as heart disease or lung disease. Thus, chronic destructive periodontal disease in smokers is initiated and driven by smoking. Its progression may or may not be amplified by unavoidable microbial colonization.

Alveolar Bone Loss↗

Autogenous free tooth transplantation by the two-stage operation technique. An analysis of treatment factors.

Teeth were autogenously transplanted by the 2-stage technique in adult patients and examined up to 5 years after surgery for the prevalence of, and correlation between, tooth graft loss, root resorption, ankylosis, periodontal attachment loss, tooth mobility, and pain. The influence on the dependent variables of independent variables related to the patient, the donor tooth, the recipient site, and the transplantation procedure was examined. Pain was correlated to transplanted teeth, later extracted, and teeth with periodontal attachment loss. The expected correlation of root resorption to periodontal attachment loss was not verified owing to incomplete follow-up. The older the patient was, the less root resorption was found. Variables indicative of infection of the recipient bed and of traumatic injuries to the donor tooth at the transplantation were found to be detrimental to the tooth transplant.

Adolescent↗

Rationalization of quantitative tooth surface loss data for epidemiological research.

Recent UK National Surveys have revealed a high prevalence of tooth surface loss (TSL) because of erosion in Children and Adolescents. Although digital surface mapping and surface matching techniques may be used to quantify its progression with time, reporting TSL of individuals as a function of either mean depth loss or volume loss, this can be inadequate when transferred for epidemiological analysis. For example, a tooth displaying multiple regions of depth loss may deserve to be distinguished from a tooth with a single localised area of erosion, although the total volume change may be the same. A potential solution, explored here, is to use both the quantitative wear data and colour coded surface representation plots generated by such methods to arrive at a single categorical wear score [1 (< or = 5% of surface exhibits TSL) to 5 (> or = 51% of surface exhibits TSL)]. Two examiners independently categorized, on two separate occasions, the TSL of 53 maxillary incisors (26 subjects observed at baseline and 9 months). Their performance was assessed for intra- and inter-examiner agreement by; (i) calculating the percentage of agreement, (ii) a Wilcoxon matched-pairs signed rank test. Thereafter, in cases of disagreement a consensus score was allocated and a regression analysis of this versus the numerically derived percentage of the surface that had undergone change was carried out. Intra- and inter-examiner agreement was 100 and 88.7% respectively and for the inter-examiner comparison P = 0.0456. The categorical scores and the quantitative wear data correlated linearly (R = 0.82). It is concluded that the method used to rationalize the quantitative TSL data is both reproducible and reflects the quantitative data. Its use should be helpful in epidemiological TSL studies but continued vigilance is required in cases of examiner disagreement.

Adolescent↗

[Skeletal and mandibular bone mineral density in dentate and edentulous postmenopausal women].

Tooth loss is one of risk factors for osteoporosis. Reversibly osteoporotic condition is one of putative risk factors for tooth loss. The balance of bone remodeling in jawbone shift to absorption in systemically osteoporotic individuals and result in enhancement of tooth loss. The presence of tooth and skeletal and mandibular bone metabolism may relate to one another. We investigated the relationship between the presence of the tooth and skeletal and mandibular bone mineral density (BMD) in postmenopausal women. Periodontally healthy and edentulous subjects participated in this study. BMD of the lumbar spine and mandibular bone was determined. The results suggest that the presence of tooth contribute to maintain the BMD of mandibular cortical bone in postmenopausal women. Direct masticatory forces via natural teeth may influence the mandibular cortical bone metabolism and if tooth loss occurs, the bone metabolism may be regulated similar to other skeletal bone.

English Abstract↗

Causes and pattern of missing permanent teeth among Kenyans.

OBJECTIVE: To determine the causes and pattern of missing permanent teeth among Kenyans. DESIGN: A descriptive cross-sectional study. SETTING: Five districts in Kenya. SUBJECTS: Seven hundred and twenty two persons aged 6-85 years (346 males and 376 females). METHODS: This study was undertaken in October 2001 during the National Dental Health Action Month organised by the Kenya Dental Association. Six centres in five districts were identified and subjects randomly selected. Intra- oral examination was done visually and results were recorded on specially designed clinical examination forms. RESULTS: The mean number of missing teeth in the population was 1.60. Among those with missing teeth, the mean number of missing teeth was 3.35. The most commonly missing teeth were lower molars followed by upper molars. No record of complete edentulousness in both jaws was encountered. Dental caries was the commonest cause of tooth loss (52.6%), followed by periodontal disease (27.6%). Extractions, as a form of traditional practice, accounted for 12.3% of total tooth loss. Orthodontic treatment and trauma accounted for 2.2% and 2.0% respectively of total tooth loss. The upper and lower posteriors were the commonest teeth lost due to dental caries and periodontal disease. Teeth lost due to trauma were mostly upper anteriors, whereas those extracted due to traditional practices were exclusively lower anteriors. CONCLUSION: The findings of this study show that the commonly lost teeth are molars and the principal cause of tooth loss is dental caries followed by periodontal disease. Overall, very few extractions had been done for orthodontic reasons.

Adolescent↗

Patterns of tooth surface loss among winemakers.

There are a few documented case studies on the adverse effect of wine on both dental hard and soft tissues. Professional wine tasting could present some degree of increased risk to dental erosion. Alcoholic beverages with a low pH may cause erosion, particularly if the attack is of long duration, and repeated over time. The purpose of this study was to compare the prevalence and severity of tooth surface loss between winemakers (exposed) and their spouses (non-exposed). Utilising a cross-sectional, comparative study design, a clinical examination was conducted to assess caries status; the presence and severity of tooth surface loss; staining (presence or absence); fluorosis and prosthetic status. The salivary flow rate, buffering capacity and pH were also measured. Thirty-six persons, twenty-one winemakers and fifteen of their spouses participated in the study. It was possible to show that there was a difference in terms of the prevalence and severity of tooth surface loss between the teeth of winemakers and those who are not winemakers. The occurrence of tooth surface loss amongst winemakers was highly likely due to frequent exposure of their teeth to wine. Frequent exposure of the teeth to wine, as occurs among wine tasters, is deleterious to enamel, and constitutes an occupational hazard. Erosion is an occupational risk for wine tasters.

Adult↗

Attachment loss with postmenopausal age and smoking.

To determine whether postmenopausal bone loss and factors associated with osteoporosis affect tooth retention, we examined vertebral and proximal femoral (postcranial) bone mineral density in relation to tooth loss and attachment loss in a cross-sectional study of 135 postmenopausal women (age range 41-70 yr). Women had at least 10 teeth and no evidence of moderate or severe periodontal disease. Full-mouth attachment loss measurements were made using a pressure-sensitive probe, and bone density was determined by dual-energy X-ray absorptiometry. Attachment loss was correlated with tooth loss (number of remaining teeth, radiologically determined), but not with vertebral or proximal femur bone density. Multivariate analysis showed current smoking (p = 0.01), years since menopause (p = 0.02) and the interaction of age and current smoking (p < 0.01), to be statistically significant predictors of attachment loss in our study population.

Absorptiometry, Photon↗

Periodontal and restorative considerations of molar uprighting.

The sequelae to the loss of a tooth are both numerous and varied. Furthermore, the ramifications of tooth loss increase in severity with time. Consequently, corrective therapeutic measures can become complex both in the diagnosis and treatment of these situations. As the demand for more predictable treatment results grows, the requirements for more efficacious treatment modalities grow as well. Therefore, the need for interdisciplinary treatment within the various areas of dentistry to assist in the complex rehabilitation becomes very important. The purpose of this article is to examine the various benefits of molar uprighting from periodontal, orthodontic, and restorative viewpoints, and to suggest a classification whereby the clinician is directed toward a multidisciplinary treatment approach.

Adult↗

Oral implications of osteoporosis.

OBJECTIVES: The association between osteoporosis and oral health remains a matter of controversy. It is important to confirm whether there is a role of osteoporosis in bone loss in the jaws, periodontal diseases, tooth loss, and other oral tissue changes. The objective of this article is to review and summarize the published literature on the associations between osteoporosis and various oral conditions such as bone loss in the jaws, periodontal diseases, and tooth loss. METHODS: A search of the computerized database MEDLINE was conducted. Clinical information concerning systemic osteoporosis and animal studies reporting possible associations between osteoporosis and changes in the dental and oral tissues were included. The review focus was on studies involving (1) methods for assessing bone mineral density (BMD); (2) methods for assessing osteoporosis-related changes in intraoral sites; (3) associations between mandibular BMD and skeletal BMD; (4) changes in the jaws, periodontal tissues, and temporomandibular joint concurrent with osteoporosis; (5) changes in the oral tissues following estrogen deficiency; and (6) effects of estrogen-hormone replacement therapy and/or calcium and vitamin D on oral health. RESULTS: Ninety-seven studies conducted in various parts of the world were identified. Evidence from prospective studies supports the contention that individuals with osteoporosis may be at increased risk for the manifestations of oral osteoporosis; however, such risk is not definitively proven. Studies suggest that findings on dental panoramic radiographs may be used to detect individuals with low BMD. CONCLUSIONS: Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully provide early warning for osteoporosis risk.

Alveolar Bone Loss↗

Socio-demographic risk indicators for tooth mortality in rural Sri Lankans.

To explore the socio-demographic factors associated with tooth loss in rural inhabitants of Sri Lanka, a random sample of 2178 males aged 20-60 years was selected using multi-stage cluster sampling procedure. The number of missing and present teeth was recorded excluding third molars and the subjects were interviewed to elicit socio-demographic information as well as oral hygiene and tobacco consumption habits. The mean number of teeth lost in the sample was 5.17 +/- 5.43. Tooth loss increased significantly with age. Sinhalese had significantly fewer lost teeth (5.05 +/- 5.38) compared to Tamils (6.54 +/- 6.18) and Muslims (6.02 +/- 5.21) whereas education, income, oral hygiene practices and tobacco use were significantly associated with tooth loss in the bivariate analysis. A forward stepwise multiple regression analysis revealed that age, Muslim ethnicity and quantified tobacco use were positively associated with tooth loss while better socio-economic conditions and good oral hygiene habits were negatively linked with tooth mortality independent of other factors. Age, Muslim ethnicity, quantified tobacco use, income, education, brushing frequency and substance used for cleaning had significantly affected tooth loss. Quantified tobacco use and oral hygiene may be regarded as modifiable socio-demographic risk indicators associated with tooth mortality in Sri Lankans.

Adult↗

Aggravated loss of tooth structure.

Self-inflicted tooth modification other than ritual mutilation practised in some countries is a rare occurrence. The author reports a case of aggravated loss of tooth structure where a patient has contributed to loss of tooth structure by the novel method of adjusting his natural teeth with a 'knife'. Subsequent management of the case is discussed.

Denture, Overlay↗

Recognition and management of occlusal disease from a hygienist's perspective.

Dental disease can be described as a permanent alteration of loss or function of those parts generally cared for by dentists. Specifically, these include the teeth, periodontal tissues and associated dental structures. Historically the breakdown and subsequent loss of tooth structure was caused by dental caries. It has also been observed that tooth loss can result from overuse-abuse referred to as bruxism or bruxamania.

Bruxism↗