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PubMed1999

Root lesions in a group of 50-60 year-old Germans related to clinical and social factors.

From a preventive point of view collection of data concerning carious and non-carious cervical tooth defects is definitely important. Consequently, the prevalence and distribution of different root lesions were studied and correlated with behavioral and biological factors in 50- to 60-year-old German individuals (n = 298). Additionally, the data were correlated with characteristics concerning oral health and known risk factors such as gender, educational level, and presence of plaque. An interview included questions on sociodemographic and socioeconomic characteristics, dental and general health status, and various behavioral parameters. During clinical examination data concerning coronal and root lesions, restorations, probing depth, gingival bleeding, and dental plaque were obtained. The participants represented a social middle class population with a high awareness of dental health. Obviously, for the participants, known risk factors for root decay such as gender, educational level and plaque index were of minor importance. Factors correlating with root caries were: (a) number of missing teeth, (b) probing depth, (c) smoking habit, (d) regular dental attendance and (e) the reason for the last dental treatment. Additionally, the prevalence of non cariogenic lesions, primarily resulting from increased but wrongly performed oral self care, seems gradually to relieve carious root destruction.

DMF Index↗
PubMed1996

Regional bond strengths of resins to human root dentine.

OBJECTIVES: The demand for restoration of root dentine defects such as cervical erosion and root caries has significantly increased recently, but there is limited information on the performance of the adhesive resins to radicular dentine. The purpose of this study was to measure the regional tensile bond strength (TBS) of composite bonded to human root and coronal dentine, and to observe the interface between resin and root dentine by SEM. METHODS: Human extracted cuspid teeth were used to measure TBS with a new microtensile bond test. Enamel and cementum were removed from the labial tooth surfaces to form a long cavity preparation into dentine from the mid-crown to the apex of the root within the same tooth. All Bond 2 (all etch technique) or Imperva Bond (no etch) was bonded to dentine surfaces and covered with Protect Liner resin composite. The resin-bonded teeth were serially sliced into 16 sections at right angles to the long axis of the tooth, and the bonded surfaces were trimmed to give a bonded surface area of 1 mm2 for TBS testing. RESULTS: All Bond 2 bond strengths to coronal and apical dentine showed high values (23.5 MPa) but the bond strength was significantly lower on cervical root dentine. Imperva Bond produced a relatively high tensile bond strength to all regional areas. SEM showed that the thickness of the resin-infiltrated layer formed by All Bond 2 in root dentine was less than coronal areas. Resin infiltration with Imperva Bond was always less than 0.5 micron. The results suggest that high TBS values can be obtained with minimal resin infiltration in root dentine.

Acid Etching, Dental↗
PubMed1993

Oral health status of a group of elderly Canadian Inuit (Eskimo).

Fifty-four Inuit elders, representing 90% of the individuals 60 yr of age and older in three communities in the Keewatin region of the Canadian Northwest Territories, were examined for dental caries, periodontal disease, levels of edentulism, and the fit and quality of denture prostheses. These elders had a mean of 2.8 +/- 3.5 decayed teeth and a DMFT of 26 +/- 13 which reflected significant tooth loss. The Root Caries Index for subjects with gingival recession was 19%. Periodontal pocket assessments revealed that 86% of the individuals examined had CPITN readings of either 3 or 4. Over one third of the elders were totally edentulous, most of them female. Only 47% of these individuals wore complete dentures. Denture fit assessment revealed that 36% of the complete maxillary dentures and 42% of the complete mandibular dentures fit poorly. The overall oral health findings for these Inuit elders differed from those found in other older populations; however, the present findings may be the norm for a population undergoing a cultural transition.

Aged↗
PubMed1993

The effect of propranolol on salivary gland function and dental caries development in young and aged rats.

Medications commonly used in elderly people cause hyposalivation and are associated with an enhanced prevalence of dental caries. Propranolol (a beta-adrenergic antagonist) is a commonly used antihypertensive agent that is prescribed for long-term use. The purpose of this investigation was to compare the effects of this drug on salivary composition and flow rate, and on caries, in young and aged rats. Forty young (28-day) and 36 aged (20-month) female Sprague-Dawley rats were infected with Streptococcus sobrinus 6715 and fed a cariogenic diet for 28 days. Propranolol was given in high (20 mg/kg/day) and low (10 mg/kg/day) doses via osmotic pumps. Unoperated and desalivated animals served as controls. Smooth-surface caries scores in the young animals receiving propranolol at 20 mg/kg/day were statistically higher than in the young intact rats (p < or = 0.05). Increased smooth-surface and sulcal caries scores were recorded in the aged propranolol-treated animals, but the differences were not statistically significant when compared with those in intact aged animals. Propranolol in aged animals did not affect the amount of alveolar bone loss but increased the risk of development of root caries. Young animals harboured greater populations of Strep. sobrinus and total cultivable flora than did all aged groups except the desalivated group. Salivary flow rates, induced by pilocarpine, were not decreased by the chronic administration of propranolol. Although the total protein concentration in parotid and submandibular saliva from drug-treated animals was reduced, differences were not observed in their SDS-PAGE profile when compared with unoperated animals. The findings demonstrate that chronic use of propranolol reduced the total protein concentration in saliva of all animals, increased caries susceptibility, but did not reduce the stimulated salivary flow rate.

Aging↗
PubMedDate not supplied

[Dental caries].

Recent studies on the etiology and prevention of dental caries are synthetized. Caries is an infectious disease produced by the bacterial plaque where microorganisms act upon hydrocarbon substrate producing acids (lactic, pyruvic, acetic, etc.). These acids decalcify the enamel surface producing the carious cavity. The three types of caries are mentioned: 1. The sucrose-dependent caries on the free surfaces of the tooth with the Streptococcus mutans predominance. 2. The pits and fissures caries with Lactobacillus acidophilus predominance. 3. The root caries with Acinomyces viscosus predominance. Caries prevention points out to three aspects. 1. Increasing tooth resistance through the use of ingested fluoride and/or topical fluorides and pits and fissure sealants. 2. A profuse and promising research work on control of microbial plaque is being done. Meanwhile, the correct and periodically controlled toothbrushing is still the most efficient preventive measure. 3. Diet control. Being carbohydrates a deep rooted habit of our modern culture, its control has to be carefully evaluated. A judicious and reduced strategic consumption of carbohydrates and the use of substitutes are useful ways of achieving the preventive aims.

Dental Caries↗
PubMed2000

Oral health status in an institutionalised elderly Jewish population.

The oral health status and treatment needs of 95 institutionalised elderly Jewish persons were determined. The mean DMFT was 23.4, with the M component increasing with age. Untreated carious lesions were identified in men and women of all ages. A relatively small percentage (10.5%) of subjects were affected by root caries. In 75% of cases of identified periodontal disease, the condition presented as bleeding or calculus. All subjects were in need of oral hygiene instruction and 64 (67.3%) required scaling and root planing. Complex treatment formed only a small percentage of the overall treatment needs. A low prevalence of temporomandibular joint problems, denture stomatitis and angular cheilitis was noted. A relatively high prevalence of untreated oral disease of low severity was observed, indicating the need for a comprehensive form of preventive and basic oral care.

Age Factors↗
PubMedDate not supplied

The reasons for tooth extractions in adults and their validation.

OBJECTIVES: To investigate the primary reasons for the extraction of permanent teeth in adults and to validate the dentists' reasons for extraction. METHODS: Twenty-one dentists in the Greater Manchester area took part in the study. These dentists provided extracted teeth stored in 10% buffered formal saline together with details of the patient's age, sex, dental attendance pattern and the reason for extraction. In order to validate the reasons for extraction, teeth were examined for the presence or absence of coronal and root caries. A subgroup of 80 teeth, half of which were extracted primarily for caries and half for periodontal reasons were selected, stained and attachment loss measured at six sites per tooth to validate periodontal reasons for extraction. RESULTS: Three hundred and eighty-nine teeth were collected of which 37% were extracted primarily due to caries and 29% due to periodontal disease. Caries was the main reason for extraction in patients under 50 years, whereas periodontal disease was the commonest reason in the over-50 age group. Irregular attenders had more extractions for caries than regular attenders but attendance pattern did not affect the proportion of teeth extracted for periodontal reasons. The mean greatest loss of attachment on teeth extracted for periodontal reasons was 12 mm compared with 6.5 mm for caries. CONCLUSION: In this group of patients caries was the most common reason for extraction of teeth but periodontal disease became a more important reason for extraction after 50 years of age. The study validated the dentists' given reason for extraction.

Adolescent↗
PubMed1998

Artificial caries formation around fluoride-releasing restorations in roots.

Secondary caries is one of the most important factors leading to replacement of dental restorations. This investigation assessed the capacity of fluoride-releasing restorative materials to resist caries in vitro when used in roots. Class 5 cavities were prepared in the buccal and lingual surfaces of 30 extracted premolars. The six materials used were: glass-ionomer cement (Fuji), glass-ionomer cement with silver particles added (Ketac-silver), fluoride-containing composite resin (Tetric), composite resin (Silux plus), fluoride-containing amalgam (Fluor-Alloy) and high-copper amalgam (Dispersalloy). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that repair with glass-ionomer materials of a carious lesion may be of great importance in the prevention of secondary caries around the restorations in roots.

Bicuspid↗
PubMedDate not supplied

Relationship between prosthodontic status, caries, and periodontal disease in a geriatric population.

This study evaluated the influence of prosthodontic status on caries a and periodontal disease in a hospitalized population of elderly people. Among the data gathered was information on caries, gingival condition, oral hygiene, plaque accumulation, and factors related to the prevalence, type and quality of the prostheses present. There was no significant association between the type of rehabilitation and the economic, social, or educational variables, but it appeared that removable partial denture wearers had less concern for oral health. Root caries and periodontal diseases were more frequent when the restoration, either fixed or removable, was defective. Th results of this study indicate the importance of oral hygiene instruction and regular recalls among removable partial denture wearers.

Aged↗
PubMedDate not supplied

Dental needs of the elderly in the 21st century.

The average age of the world's population is increasing rapidly. The "graying of America" presents new opportunities and new challenges for improving the oral health of the elderly, particularly those afflicted with neurocognitive impairments. The dental problems associated with these conditions include but are not limited to a decrease in oral hygiene; difficulty in controlling and retaining dentures; xerostomia, which often is drug-associated, and consequential root caries, recurrent decay, and purposeless chewing. Parkinson's disease and Alzheimer's disease are the most prevalent type of progressive neurocognitive impairing illnesses, affecting millions of elderly Americans. As the adult population increases, a greater number of patients with these diagnoses will require dental care. Dental providers need to be aware of the special problems associated with the treatment of the older healthy subject and the neurocognitively impaired patient.

Adult↗
PubMed1994

Etiology and treatment of root hypersensitivity.

Class V cervical lesions are often observed in older patients during their treatment planning phase, resulting from root caries, toothbrush abrasion, chemical erosion, or to absraction due to unusual tooth flexure. Besides providing a nuisance space as a food trap or plaque buildup, patients also complain of hypersensitivity to air blasts, mechanical stimulation, thermal extremes, or to osmotic fluid shifts. The location of the root lesion in relation to the cemento-enamel junction is of extreme importance. For that reason root lesions limited to the coronal portion of the tooth and completely surrounded by enamel lend themselves to traditional restorative treatment procedures. However, as the root lesion moves apically and its cavosurface circumference is increasingly bound by cementum, clinical treatment becomes much more difficult and in most cases virtually impossible with conventional retentive restorations, and they tend to threaten the root structure and the dental pulp. If these root lesions are left untreated, progressive destruction of root structure occurs and if the causative agents are not removed, the depth of the lesion will threaten the periodontium, dental pulp, and the occlusal integrity of the tooth crown. In addition, cemental lesions are often associated with increased levels of hypersensitivity. Historically, dentistry treated root lesions with direct gold, gold or porcelain inlays, amalgam alloys and crowns, all relying on resistance and retention form. When unrestorable, modification of tooth-brushing techniques along with desensitizing agents were the only desirable treatment due to problems involved with the insertion of a proper restoration. Clinical studies have reported these procedures are often transient, offering no durable restoration of the tooth or elimination of the hypersensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Restoration, Permanent↗
PubMed1993

Oral health status of the elderly in New England.

The New England Elders Dental Study (NEEDS) reports the prevalence, extent and severity of oral diseases and conditions among a representative sample of community-dwelling elders age 70 and older residing throughout the six New England states. In-home, full-mouth examinations were conducted by four calibrated dentists who used National Institute of Dental Research (NIDR) standardized disease measures plus additional diagnostic codes on all tooth surfaces. Only 37.6% of elders age 70 and older were edentulous, while dentate elders had a mean number of teeth per person ranging from 21.5 to 17.9 across age and gender cohorts. The prevalence of untreated coronal decay in elders with teeth was 28% in female elders and 34% in male elders. More than 90% of all elders with teeth had coronal fillings and 22% exhibited untreated root caries. Periodontal destruction was substantial, with 66% of dentate elders exhibiting moderate periodontal pockets (4-6 mm) while 21% exhibited severe periodontal pocketing (> 6 mm). Comparisons with national surveys suggest that periodontal disease prevalence and severity appear to have been underestimated in previous national studies of the elderly. Because of aging and tooth retention trends, the periodontal disease problem of the elderly may be increasing in the face of dentists' tendency to underdiagnose the periodontal diseases, legal constraints on dental hygienists to independently treat them, and inadequate funding for conservative nonsurgical therapies.

Aged↗
PubMed2004

Impact of socio-demographic variables, oral hygiene practices, oral habits and diet on dental caries experience of Indian elderly: a community-based study.

UNLABELLED: A number of factors influence the caries experience and the pattern of restorative care especially in the older age group. OBJECTIVE: To evaluate the dental caries experience and restorative treatment needs of an elderly Indian population and to study the impact of socio-demographic variables, oral hygiene practices, oral habits and dietary practices on them. DESIGN: A community-based study. SETTING: An urban area in the south zone of Delhi and a cluster of four villages in its neighbourhood. SUBJECTS: A total of 1240 elderly subjects, 716 urban and 524 rural, were included in the study. RESULTS: Of the 1052 dentate elderly subjects, 676 (64.2%) had decayed teeth (66.7% root caries and 33.3% coronal caries), 69 (6.6%) had filled teeth and 17 (1.6%) had recurrent decay. Restorations were indicated in 233 (22.2%) subjects, endodontic treatment in 51 (4.8%) and extractions in 424 (40.3%). Urban-rural differences in caries experience were statistically significant. Multivariate regression analysis showed that dental caries was associated with literacy level, oral hygiene practices, oral health perception and diet, while previous restorative treatment was correlated only with location (urban-rural) and presence or absence of systemic diseases. CONCLUSION: Dental caries prevalence was high amongst the studied elderly population and significant differences were observed in those living in a rural compared with an urban setting. Only a small percentage of elderly had evidence of previous restorative treatment whereas their unmet treatment need was significant.

Aged↗
PubMed1989

Causes of tooth loss in a veteran population.

Tooth loss in adults over age 35 usually is attributed to periodontal diseases. However, certain adult populations are known to have high caries rates. It is not clear to what extent caries contributes to tooth loss in adults. This pilot study examined the causes of tooth loss in a veteran population residing in an 800-bed, primarily long-term care facility. The study retrospectively reviewed 572 patients' dental records and documented causes for dental extractions. Of the sample population, 168 teeth were extracted in 51 patients who had 860 teeth present before treatment. Mean age of the patients undergoing extractions was 57.7 years, lower than the sample population of 60.1 years. Of the 168 teeth extracted, 105 (63%) were attributed to caries and 33 (20%) were documented as root tips, suggesting the presence of root caries. Fifty-five (33%) were extracted due to periodontal disease and six (4%) were extracted for prosthodontic reasons. Of the maxillary teeth, 67 percent were extracted for caries and 25 percent of periodontal reasons. Caries accounted for 57 percent and periodontal disease accounted for 42 percent of the mandibular teeth extracted. The order in which teeth were most frequently extracted was maxillary anteriors, mandibular anteriors, maxillary and mandibular premolars, and maxillary and mandibular molars. This study supports the recent work of authors who have found caries contributing significantly to tooth loss in adult populations.

Adult↗
PubMed1987

Scanning microscopic observations on dental caries.

This paper presents findings made using special techniques of imaging and/or of specimen preparation to investigate the changes in tooth structure which occur in caries. We have studied both coronal and root caries in enamel, dentine and cementum using scanning electron and confocal scanning optical microscopy. In preparation for backscattered electron (BSE) imaging in the SEM, teeth were stored in 70% ethanol until further dehydration in ethanol and embedding in polymethylmethacrylate (PMMA). Longitudinally cut surfaces were diamond polished and coated with carbon or silver before BSE imaging. Important changes in the distribution of densities in both enamel and dentine occurred during caries, and could be correlated with prior published studies using polarised light and microradiography to study demineralization in these tissues. However, the resolution of the BSE imaging technique is much higher than that of these previous methods. A new method was used for demonstrating local variations in microhardness with special relevance to the changes occurring in dental caries. Sectioned surfaces were subjected to treatment with a jet of soft abrasive particles, resulting in the selective removal of carious enamel, and enhanced removal of carious dentine. The tandem scanning reflected light microscope (ISRLM) has also been shown to be useful in characterising the spread of caries in the dental tissues. Teeth only need to be cut once, because the image is formed on looking into a bulk specimen. Fluorescent dyes can be used to study the distribution of pore volume, making use of the high resolution in depth of this confocal microscope.

Dental Caries↗
PubMed1998

Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility.

The aim of this study was to evaluate clinically and microbiologically the effects of a preventive oral health program in a long-term care facility. A total of 116 dentate elderly residents agreed to participate, and half of them were included in an experimental group. Almost all of the residents were mentally or physically handicapped, and many were dependent on care-givers for daily living activities. Oral examination and microbiological sampling were performed at baseline and 18 months later. The experimental group benefited from a preventive program, including an oral hygiene course for the health care providers and regular recalls by dental hygienists of the residents. After 18 months, the plaque indices were statistically similar to those at baseline in both groups. Mutans streptococci counts and active root caries at 18 months were lower compared to baseline in the experimental group but did not change significantly in the control group. Thus, it seems that, while the preventive program failed to decrease plaque indices, it was effective in reducing mutans streptococci colonisation and caries prevalence.

Activities of Daily Living↗
PubMed2003

Restorative management of the elderly patient.

It is predicted that geriatric patients will dramatically increase in number within our working lives. Although they are considered to demand treatment less frequently than the younger age groups, there are specific issues that need to be considered when providing dental treatment for these patients. The term gerodontics has been coined to describe this subject. The need to consider family relationships and the role of carers may play a greater part in their dental management than that of the general population. As well as oral disease, the incidence of general disease is higher in this population, as is the amount of medication prescribed to treat it; these factors often complicate dental management. Special problems that will have a high dental impact on the geriatric patient may be lack of adaptive potential, poor plaque control, root caries, periodontal breakdown and levels of toothwear.

Aged↗