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PubMed2003

The rational use of oral care products in the elderly.

This review examines the evidence of the effectiveness of oral care products in preventing and controlling dental caries and periodontal disease in the ageing population. The strength of evidence is indicated using the following hierarchy: Type 1 (systematic reviews), Type 2 (randomised controlled trials), Type 3 (observational studies) and Type 4 (traditional reviews). Most of the evidence to support the effectiveness of fluoride products is extrapolated from studies involving children and adolescents. The few studies that have been performed in older adults suggest that fluoride toothpaste and, in the case of high caries risk individuals, the adjunctive use of other fluoride delivery systems, may be effective in preventing coronal and root caries. Some dentifrices containing triclosan have been shown to improve plaque control and gingival health and one, which contains triclosan/copolymer, reduces the progression of periodontitis in adults and high-risk individuals. Powered toothbrushes with an oscillation-rotation action are more effective in reducing plaque and improving gingival health than manual toothbrushes.

Aged↗
PubMed1991

Root-retained overdentures: Part I--Biomechanical and clinical aspects.

Despite recent developments in dental implantology, the conservative approach to root preservation is still valid. In view of increased root caries rate in the elderly and lax oral hygiene habits of most overdenture wearers, placing protective copings on root abutments, when economically feasible, is the preferred method of treatment. Retention of overdentures is increased by including stud attachments in the abutments. Incorporation of cast metal frameworks is recommended to prevent base fractures.

Biomechanical Phenomena↗
PubMedDate not supplied

A comparison of the effectiveness of two systems for the prevention of radiation caries.

The purpose of this study was to compare the effectiveness of two systems for the prevention of dental caries in patients who have received radiation treatment (mean number of rads; 5672 +/- 1113) for head and neck cancer. The baseline examination of 184 dentulous patients included measures of DMFS and the Root Caries Index (RCI), field of radiation, gingival inflammation, oral hygiene status, pocket depth and attachment loss. The patients were assigned randomly into two treatment groups. One group was instructed to use 0.4% Sn2 gel while toothbrushing everyday, and the other group was instructed to use a 1.1% neutral NaF gel for three months, followed by twice daily rinsing with a remineralizing mouthrinse (Salminsol Solutions, Iowa City, Iowa). One hundred and forty-three patients were re-examined after one-year, and 69, 56 and 18 patients continued in the NaF gel/remineralizing mouthrinse, SnF2 and non-compliant groups, respectively. Inter-group comparisons showed that the incidence of MT, DMFT, and DF surfaced, and the RCI were significantly higher in the non-compliant group compared to either the SnF2 or NaF gel/remineralizing mouthrinse groups (P less than 0.05). Also, the NaF gel/remineralizing mouthrinse group demonstrated a significantly higher incidence of carious root surfaces compared to the SnF2 group (P less than 0.05). Also the incidence of radiation caries was significantly higher when the field of radiation exposed a greater surface area of the major salivary glands.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1992

Epidemiology of dental diseases in the elderly.

The aging of the American population will have enormous social ramifications, among which will be a greater focus on the elderly patient. Traditionally, the dental status of this group has been extracted teeth and full dentures, but that is now steadily changing. There were 41.1% of Americans aged 65 or older who were edentulous in 1985 to 1986, but a good proportion of them have been edentulous for many years. The prevalence of total tooth loss will continue to decline with time. The growth of a dentate elderly population, however, leaves more of that group at risk of caries. Caries, once seen as a disease of childhood, is now clearly a lifelong disease. Elderly persons are particularly at risk of root caries, which follows as a consequence of periodontitis. Total tooth loss and severe caries are both associated with lower socioeconomic status. Although cross-sectional survey data invariably show, on average, a greater extent of periodontitis among older than among younger persons, periodontitis is not considered a disease of aging. The age difference in surveys is not because of greater susceptibility among the elderly but represents disease accumulated over time. Limited longitudinal data suggest that rapid loss of periodontal attachment, serious enough to threaten the dentition, is found in 7% to 15% of any population. But this group exhibits the disease when young. Those who have retained a more-or-less intact dentition into old age rarely exhibit a sudden onset of periodontitis. If such a change is seen it could be indicative of broader changes in the immune system.

Aged↗
PubMedDate not supplied

Effects of a 1% chlorhexidine gel on the cariogenic bacteria in high-risk elders: a pilot study.

Root caries in dentate elderly patients is a problem which may be controlled with chlorhexidine. The purpose of this pilot study was to establish the extent and duration of the antimicrobial effects from an intensive regimen of a 1% chlorhexidine gel in institutionalized elders who had experienced high caries activity in the previous year. Stimulated saliva samples from all subjects before treatment produced more than 105 colony forming units/milliliters of Streptococcus mutans (mean: 2.0 x 10(7); s.d.: 2.0 x 10(7)) when diluted and cultured on Mitus Salivarius-bacitracin agar for 48 hours. Findings suggest that daily treatments for 1 week with a 1% chlorhexidine gel can reduce the number of cariogenic bacteria in elderly people for approximately 3 weeks after treatment.

Aged↗
PubMedDate not supplied

Correlation between clinical scoring of secondary caries at crown margins and histologically assessed extent of the lesions.

PURPOSE: The aim of this study was to propose a new clinical diagnostic rating index for secondary caries lesions at crown margins and to correlate this index with histologic evaluations. MATERIALS AND METHODS: Based on criteria for the evaluation of root caries, a modification of secondary caries lesions at the crown margin (SC index) was applied; the lesion characteristics were described as SCO to SC4. A total of 16 crowned teeth exhibiting secondary caries were randomly selected. The teeth were rated and grouped according to their clinical SC grades (SC1 to SC4). After embedding in Technovit, the teeth were serially sectioned and histologic caries scores were given for each section. RESULTS: Fifty-two percent of the prepared margins were in cementum/dentin. Crown margins with no caries lesions were mainly found in teeth clinically rated as SC1 and exhibiting localized discolorations, whereas deep lesions were found histologically at teeth rated SC4. The nonparametric test according to Spearman's rank correlation coefficient (rho) confirmed a highly significant correlation between the clinical SC index and the histologic evaluation (rho = 0.87, 95% confidence interval = 0.67 to 0.96, P < 0.01). SC1 discolorations overestimate caries lesions, whereas SC2 and SC4 lesions are well correlated to the percentage of histologically evaluated caries extension into all sections of a tooth. Lesions rated SC3 demonstrated a high variability of caries penetration into the dentin. CONCLUSION: The depth of discolorations and circular lesions is clinically not well predictable. Clinical diagnosis for localized superficial caries and deep caries lesions at the crown margin correlated well with the histologic caries rating.

Adult↗
PubMedDate not supplied

Anti-hypertension medications: an epidemiological factor in the prevalence of root decay among geriatric patients suffering from hypertension.

Predictions showing age distribution in our population of elderly citizens in our society within the next 30 to 40 years. One of the most destructive oral afflictions of the elderly is root decay. A study was performed to ascertain the prevalence of root caries among inner city geriatric patients taking anti-hypertension medications. One hundred randomly selected patients were studied. Fifty patients taking the anti-hypertension medications for at least two years were compared to a control group of 50 healthy patients of nearly the same age. With oral hygiene factors being equal, the group taking anti-hypertension medications demonstrated a higher prevalence of root decay at the p less than 0.01 level.

Aged↗
PubMed1994

Fluoride toothpastes, rinses, and tablets.

Only from the mid-1950's has therapeutic benefit been obtained via dentifrices, initially with stannous fluoride-then monofluorophosphate-containing products which remained stable and efficacious. Altered abrasive systems followed, and both sodium fluoride and monofluorophosphate/sodium fluoride mixtures were introduced as active anti-caries agents, with recent meta-analysis indicating that sodium fluoride > monofluorophosphate/sodium fluoride > monofluorophosphate. With respect to fluoride levels, clear dose-response relationships have been demonstrated. However, at < 1000 ppm F, the situation is less certain. Since the mid-1980's, anticalculus fluoride dentifrices have been marketed, and have been shown to have similar caries-reducing potential as their non-calculus-inhibiting control formulae. Finally, one study has been described where a sodium fluoride dentifrice successfully reduced root caries. Of the many fluoride formulations used for caries-inhibiting mouthrinsing [e.g., acid phosphate fluoride (100-3000 ppm F), sodium fluoride (45-3000 ppm F), stannous fluoride (100-250 ppm F), ammonium fluoride (1000 ppm F), and amine fluoride (250 ppm F)], sodium fluoride would seem to be the preferred agent. Furthermore, rinse frequency is deemed more important than fluoride ion concentration, but caution is urged re the volumes and concentrations to be used by children, no rinsing being recommended below 4 years. Combination of a 440-pp-F sodium fluoride and 0.05% chlorhexidine school-administered rinse appears to have increased the caries-inhibiting benefit as compared with sodium fluoride alone. Fluoride supplements have reduced deciduous caries from 14 to 93%, and in the permanent dentition, from 20 to 81%.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluorides↗
PubMed1995

The value of anti-caries and anti-plaque dentifrices at a community level.

Although dentifrices (in a modern sense) were first introduced at the turn of the century, it was not until the advent of fluoride-containing compounds that any of therapeutic value was produced. In the early post-war years, formulation compatibility difficulties occurred, with the result that none was demonstrated to have clinically proven efficacy until stannous fluoride was successfully incorporated in the "Crest" formulation of 1955. Thereafter, sodium monofluorophosphate (SMFP) appeared, to be followed by organic and acid-phosphate fluoride preparations, most of which were shown to produce clinical benefit over placebo controls. Since the late 1970's, however, such studies have been deemed unethical in many countries in view of the almost universal availability of efficacious fluoride dentifrices. While an NaF formulation was the first to be tested (albeit unsuccessfully) by Bibby (1945), there was a considerable time period before the arrival of both stable and effective silica-based systems in the early 1980's. Results of studies have varied, but the largest ever double-blind NaF/SMFP head-to-head dentifrice trial yet published (Stephen et al., 1994) has indicated a 6.4% significant benefit in favor of NaF (in silica) over SMFP. With respect to the effect of dentifrice fluoride levels, above 1000 ppm dose-response caries reductions have been obtained, but the efficacy of preparations containing 500 ppm F or less has yet to be demonstrated. In relation to root caries, Jensen and Kohout (1988) reported a 41.4% DFS significant reduction in subjects who used a NaF/silica dentifrice at 1100 ppm F, over a one-year period.

Clinical Trials as Topic↗
PubMed1994

Saliva stimulation and caries prevention.

The protective role of saliva is demonstrated by the rampant caries seen in human subjects with marked salivary hypofunction, and in desalivated animals. In normal cases, however, the relationship between saliva flow and coronal or root caries experience is doubtful, and to examine the concept that stimulation of saliva might have protective effects against caries, one must look beyond a simple correlation between caries and flow rate. Protective properties of saliva which increase on stimulation include salivary clearance, buffering power, and degree of saturation with respect to tooth mineral. These benefits are maximized when saliva is stimulated after the consumption of fermentable carbohydrates, by reducing the fall in plaque pH leading to demineralization and by increasing the potential for remineralization. Plaque acid production is neutralized, and experimental lesions in enamel are remineralized, when gum is chewed to stimulate saliva after a carbohydrate intake. The pH-raising effects are more easily explained by the buffering action of the stimulated saliva than by clearance of carbohydrates. The remineralization action depends upon the presence of fluoride. These findings suggest that the protective actions of saliva can be mobilized by appropriate salivary stimulation, and that in addition to established procedures such as tooth cleaning and fluoride regimens, eating patterns which lead to saliva stimulation to increase the potential for saliva protection might be included in recommendations for caries prevention. Confirmation of this concept in clinical tests is required.

Dental Caries↗
PubMed2006

Rehardening of caries-like lesions in root surfaces by saliva substitutes.

OBJECTIVE: This study sought to evaluate whether root dentine caries-like lesions could be remineralised by saliva substitutes. METHODS: Root dentine slabs (3 x 3 x 2 mm) were cut from bovine incisors, ground flat, polished and pre-tested for Knoop microhardness (KHN) at five locations spaced 500 microm apart and 500 microm from the left edge of each sectioned piece. After 60 out of the 100 slabs had been selected based upon their KHN values, specimens were coated with wax except for their outer surface. Specimens were then cycled through a highly cariogenic challenge model to induce caries-like lesions, whose formation was confirmed by KHN measurements located 500 microm from the right edge of the specimen. According to a randomised complete block design, the experimental units (n = 15) were exposed to 1.5 ml of saliva substitutes, based on either mucin (MC) or carboxymethylcellulose (CM), to natural human saliva (HS) or to 100% relative humidity (RH) over 20 days. Remineralisation was verified by KHN measurements located 1000 microm apart from the right edge of the specimen. RESULTS: Analysis of variance indicated a significant (p < 0.0001) difference among the KHN values attained by the carious root dentine after exposure to the remineralising agents. Tukey's test ascertained that remineralisation was greatest with MC, intermediate with CM and least with HS, but rehardening did not reach the pre-caries lesion formation values. CONCLUSION: Saliva substitutes may provide partial remineralisation to preformed caries-like lesions in root dentine.

Adult↗
PubMed1984

Fluoride-treated roots and viability and attachment of human gingival fibroblasts.

Topical fluoride treatment is used to help prevent root caries. It may also be useful in periodontal therapy because of its antimicrobial property. In addition, for therapeutic new attachment to occur, the fibroblasts approximating the treated root surface should remain viable, and should also be able to attach and grow onto the treated root surface. These conditions, at least, are required for fluoride not to interfere with new attachment. This study was designed to determine whether treatment of roots with fluoride adversely affects human gingival fibroblasts in culture; and what effect fluoride treatment has on attachment and growth of cells to the root surface. Cells originally obtained from human gingiva were allowed to grow to confluency in multi-well tissue culture petri dishes, and were then incubated for 24 hr in the presence of root sections as follows: (1) no treatment; (2) root-planed only; (3) 2% NaF only; (4) root-planed + 2% NaF; (5) root-planed + citric acid, pH 1 + 2% NaF. In addition, cells were plated onto roots similarly treated and were subsequently allowed to incubate for 72 hr. Viability of cells was determined by exclusion of vital dye and 51Cr retention. Attachment and growth of cells were determined by histology and scanning electron microscopy. Results indicated that, after 24 hours' exposure, there was little or no difference in cell viability between different treatment groups and control cultures. Also, all roots which had been planed accommodated cell attachment, regardless of additional treatment rendered.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗
PubMed2005

Level of education and incidence of caries in the elderly: a 5-year follow-up study.

OBJECTIVE: This study aimed to examine the possible association between level of education and 5-year caries increment in the elderly inhabitants of Helsinki. BACKGROUND: Low salivary flow and high numbers of salivary microorganisms are associated with the presence of caries, but cannot predict the increment in caries in the elderly. MATERIALS AND METHODS: This study group was derived from a population-based Helsinki Aging Study, which consisted of a random sample of elderly born in 1904, 1909 and 1914. The 71 dentate elderly who underwent clinical oral examinations at baseline (1990-91) and 5 years later (1995-96) were included in the study group. Decayed, Missing or Filled Tooth (DMFT) and Root Caries Index (RCI) indexes were used to study subjects' caries experience. Data on subjects' education came from questionnaire studies. The subjects were divided into four groups according to their level of education and occupation. Bivariate and multivariate analyses were used to evaluate relationships between subjects' caries experience and level of education. RESULTS: At baseline the elderly with high level of education had more teeth and more root surfaces at risk than those with low level of education. Number of teeth decreased (-1.085, p < 0.0001), while both DMFT (1.164, p < 0.0001) and RCI (0.081, p < 0.0001) indices increased during follow-up. The increments in DMFT and RCI were not directly associated with the level of education. Multivariate analysis in which subjects' gender, number of teeth, level of education, frequency of eating and frequency of brushing were taken into consideration, showed no significant association with caries increment. CONCLUSIONS: Within the limitations of this study it can be concluded that the level of education of the elderly is not directly associated with the increment in caries.

Aged↗
PubMed1992

Characteristics and cariogenicity of a fructanase-defective Streptococcus mutants strain.

Polymers of D-fructose produced by a variety of oral bacteria are believed to function as extracellular carbohydrate reserves. Degradation of these polysaccharides in plaque following exhaustion of dietary carbohydrates is thought to contribute to the extent and duration of the acid challenge to the tooth surface and thus to the initiation and progression of dental caries. Streptococcus mutans produces a fructanase, the product of the fruA gene, which is capable of degrading beta(2,6)- and beta(2,1)-linked fructans that are commonly synthesized by dental plaque microorganisms. To evaluate the role of the FruA protein in exopolysaccharide metabolism and to assess the contribution of this enzyme to the pathogenic potential of S. mutans, a fructanase-deficient strain of S. mutans was constructed. Inactivation of a cloned fruA gene was accomplished in Escherichia coli by using a mini-Mu dE transposon, and then an isogenic mutant of S. mutans UA159 was constructed by allelic exchange. Successful inactivation of fruA was confirmed through the use of biochemical assays, Western blotting (immunoblotting) with anti-recombinant FruA antisera, and Southern hybridization. The data indicated that FruA was the only fructan hydrolase produced by S. mutans UA159. Inactivation of fruA had no significant effects on glucosyltransferase or fructosyltransferase activity. In the rat caries model using animals fed a high-sucrose diet and ad libitum, there were no significant differences in the number or severity of smooth surface, sulcal, or root caries elicited by the fruA mutant and the wild-type organism.

Animals↗
PubMed2005

A comparative analysis of periapical health based on historic and current data.

AIM: To compare periapical health using samples from prehistoric and historic periods until the present day, and to emphasize the major risk indicators for apical periodontitis (AP). METHODOLOGY: A comparative survey to assess periapical health was performed on five samples (525 individuals) drawn from different periods of history within the time frame 2000 BC to 2000 AD. Twenty-one binary risk indicators for AP were retained for a logistic regression model. The probability of a diseased tooth was defined from a two-level response variable based on the periapical index (PAI). An individual regression model was computed with partial least squares (PLS) regression model, based on the individual mean values of the nine retained risk indicators. RESULTS: Condensing osteitis, tooth wear, caries, root fillings and the presence of inadequate root fillings were associated with the PAI levels. The maxillary molars and recent time periods (contemporaneous and seventeenth century) were also risk indicators for the pathological condition. The PLS regression for individuals demonstrated correlations between risk factors. This multidimensional analysis indicated that the mean PAI was correlated mainly with caries and condensing osteitis. Condensing osteitis was more frequent in the mandibular than in the maxillary bone (P=0.001), and correlated with tooth wear in ancient periods. CONCLUSIONS: This comparative analysis demonstrated a significantly higher prevalence of AP in the contemporary period. The most important risk indicators for that period were the presence of inadequate root fillings, carious lesions and condensing osteitis.

Adolescent↗
PubMed2004

Diabetes, periodontal diseases, dental caries, and tooth loss: a review of the literature.

Diabetes mellitus, is a common chronic disease, and its prevalence in the United States, particularly type 2 diabetes, is increasing. Complications associated with diabetes impose a heavy burden on many people, especially among certain minority populations. Periodontal diseases, dental caries, and tooth loss also are common conditions in the United States, but their prevalence is generally decreasing. Nevertheless, among important subgroups of the population, particularly certain minority and economically disadvantaged groups, there is a disproportionately higher burden of periodontal diseases, dental caries, and tooth loss. This article reviews the post-1960 English-language literature on the relationship between diabetes and oral health, specifically focusing on periodontal disease, dental caries, and tooth loss. Substantial evidence exists to support the role of diabetes and poorer glycemic control as important risk factors for periodontal disease. Additionally, the evidence provides support for viewing the relationship between diabetes and periodontal diseases as bidirectional. However, additional research is necessary to firmly establish that treating periodontal infections can contribute to glycemic control management and possibly to the reduction of type 2 diabetes complications. The literature does not describe a consistent relationship between type 2 diabetes and dental caries. It reports increased, decreased, and similar caries experiences between those with and without diabetes. This review suggests that currently there is insufficient evidence to determine whether a relationship between diabetes and risk for coronal or root caries exists. Most of the reviewed studies reported greater tooth loss in people with diabetes. However, the differences were slight and not significant in several of the reports. Furthermore, this review of the association between diabetes and tooth loss reveals that valid population-based evidence generalizable to the US population is sparse. Further investigations of the association of diabetes with dental caries and tooth loss are warranted. If adverse effects of diabetes on dental caries and/or tooth loss are substantiated, the results of such studies would help design intervention studies to prevent or reduce the occurrence of dental caries and tooth loss in people with diabetes. These results also may affect existing clinical practice protocols and promote new public policy related to diabetes.

Blood Glucose↗
PubMed1993

New ideas and advancing technology in prevention and non-surgical treatment of periodontal disease.

Analytical, oral epidemiological studies in adult 'toothbrushing' populations show that the highest prevalence of missing teeth is for molars and maxillary premolars ('key-risk' teeth). The highest prevalence of subgingival microflora, gingivitis (CPITN-1), plaque retentive factors, such as subgingival calculus and restoration overhangs (CPITN-2), and diseased pockets > 3 mm (CPITN-3-4) is found on the approximal surfaces of the same teeth ('key-risk' surfaces). Primary and secondary prevention, as well as treatment of periodontal disease should be focused on these 'key-risk' surfaces. One single, well-executed subgingival scaling and root-planning procedure in deep, diseased periodontal pockets, followed by oral hygiene training and professional mechanical tooth-cleaning (PMTC) at need-related intervals, will prevent further loss of periodontal attachment. However, if the root cementum is removed during instrumentation, and the post-treatment plaque control programme fails, microorganisms will recolonize and invade the rough exposed root dentine, resulting in recurrence of periodontitis and possibly, root caries and pulpitis. Some of these problems may be overcome by the application of new instruments and methods for self-care, PMTC, removal of overhangs, scaling and root-planing without removing 'non-diseased' cementum.

Dental Devices, Home Care↗
PubMed1985

The future of the caries decline.

Dental caries declined in prevalence and severity among schoolchildren in the United States during the 1970s, although it still remains a problem in some areas. The decline could have started well before the 1970s, even though it was only recently identified. Caries should continue to decline as long as fluoride use remains around current levels. Use of fluoride toothpaste seems to be increasing. Sugar consumption is stable, although sucrose consumption as a proportion of total sugar consumption is declining. Increased tooth retention is thought to increase the risk of root caries in older persons, but the continued use of fluoride toothpaste should minimize any such increase. The main growth area for fluoride use may be in toothpastes. Monitoring caries trends in the future will require good data on the epidemiology of caries in young and middle-aged adults.

Adolescent↗