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PubMed1984

A longitudinal study of untreated periodontal disease.

1016 textile workers were examined during a baseline study in 1969/70. A follow-up examination in 1979/80 identified 82 subjects who had not been treated for periodontal disease in the intervening period. There were 39 male and 43 female subjects; the average age at the initial examination was 27.0 years. There was an average tooth loss of 2.5 (SEM 0.6) teeth per subject over the 10-year period. While periodontal disease was significantly related to oral hygiene at the outset, neither factor was significantly related to the degree of tooth loss. A detailed analysis of the dynamics of the periodontal condition was undertaken. The subsequent results are presented in the form of transition matrices and clearly illustrate both the progression of periodontal disease and the degree of tooth loss associated with each level of periodontal disease at the initial examination. The main findings are as follows. (a) Overall 6% of teeth initially free of periodontal disease (P.I.O.) were lost compared to 14% with destructive periodontal disease (P.I.6). (b) Progression of periodontal disease was slow for teeth initially free of periodontal disease and with mild gingivitis (P.I.0 and P.I.1) for all age groups. However severe gingivitis (P.I.2), resulted in more rapid deterioration of the supporting tissues in subjects over 35 years old at the final examination; 35% of such teeth changed to destructive periodontal disease (P.I.6) compared to 17% of corresponding teeth for the under 35-year age group. In contrast, a poorer prognosis was found for the teeth with destructive periodontal disease (P.I.6) in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Reasons for extraction of permanent teeth in Jordan.

This investigation was carried out to determine the reasons for extraction of permanent teeth in Jordan. A random sample of 200 Jordanian Dentists (1:10) were asked to record reasons for the extraction of permanent teeth during a two week period. Of the 139 dentists responding, only 97 dentists extracted teeth during the study period. A total of 934 teeth were extracted from 582 patients, of these 33.4 per cent were extracted for periodontal disease, and 27.6 per cent because of caries and its sequelae. The study suggests caries and its consequences affected tooth loss throughout life while the rate of tooth loss due to periodontal disease increases with age.

Adolescent↗
PubMed2002

Effects of ovariectomy on trabecular structures of rat alveolar bone.

An association between postmenopausal osteoporosis and tooth loss has been proposed. However, histomorphometrical changes in alveolar bone following estrogen deficiency are rarely reported with data on microtrabecular structural changes. To clarify the relationship between estrogen deficiency and tooth loss, we histomorphometrically analyzed the trabecular structural changes of mandibular alveolar bone in ovariectomized rats. Twenty-four adult female Fischer rats were used. Eight rats were sacrificed on day 0 (baseline). The remaining 16 rats were divided into two groups. One group was ovariectomized bilaterally (OVX) and the other group was subjected to sham surgery (Sham). After administration of tetracycline and calcein, the animals were sacrificed 60 days after surgery. Bone histomorphometry, node-strut analysis and measurement of thickness of alveolar bone proper were performed on the interradicular septum of the first molar on the sagittal surface. The trabecular bone volume and trabecular number of the OVX group were significantly lower than those of the baseline and Sham groups. All of the bone resorptive and formative parameters of the OVX group were significantly higher (about one-and-a-half times) than those of the Sham group. Several osteoclasts were seen lining the irregular, eroded surface facing the bone marrow in the OVX group. Furthermore, the OVX group tended to have low microtrabecular stiffness and showed significantly thinner distal alveolar bone proper than in the baseline and Sham groups. In summary, estrogen deficiency caused osteoporotic changes and thin alveolar bone proper in the interradicular septum of rat first molar. This phenomenon might accelerate destruction of alveolar bone and tooth loss, especially in elderly women affected by periodontal disease.

Alveolar Process↗
PubMed2003

Periodontal reasons for tooth extraction in an adult population in Jordan.

This survey studies the reasons for periodontal extraction of permanent teeth in an adult Jordanian population. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. Of these, the 26 dentists who participated in this study were asked to record teeth extracted and give reasons for extraction. Personal and demographic information and clinical details were obtained from 898 patients aged from 20 to 60 years. A total of 1,098 teeth were extracted during the 3-month study period. The results of this study revealed that dental caries (56.4% overall) was the main reason for tooth extraction, especially in 20-39 year olds. Periodontal disease (23.4% overall) was the next most frequent indication for extraction and became the commonest cause of tooth extraction in patients aged 40 years or more. Other reasons for tooth loss accounted for only 20.2% of the series. Advanced periodontal disease represented by pocketing were the dominant pathology when tooth loss occurred as the result of periodontal disease. As far as the type of tooth was concerned, the most frequently extracted teeth were molars followed by premolars, regardless of whether their loss was the result of the caries or the periodontal disease. This study suggests that caries and its consequences are responsible for more tooth loss in patients less than 40 years of age while extraction because of periodontal problems increases with age, and more commonly related to pocketing.

Adult↗
PubMed1999

An exploration of oral health beliefs and attitudes of Chinese in West Yorkshire: a qualitative investigation.

This qualitative study explores oral health beliefs and attitudes among Chinese resident in West Yorkshire using six focus groups differentiated by age and gender. Focus group discussions took place in community settings led by trained Chinese facilitators. All groups believed that they were susceptible to dental disease, and that bleeding gums and total tooth loss were 'normal'; apart from the elderly, tooth loss was seen as undesirable. The elderly and adult groups believed in traditional remedies and claimed that preventive oral health measures were ineffective. These groups lacked faith in dentists, and for them cost, language difficulties and lack of awareness were the main reported barriers to accessing dental services. Traditional Chinese oral health beliefs remain influential for the elderly and adult UK Chinese. In contrast, teenagers thought that toothbrushing and sugar restriction would help to prevent dental diseases. The appropriateness of the focus group and interview methods for exploring oral health beliefs for the Chinese are discussed, as are implications of the reported intergenerational differences for oral health promotion strategy in the UK.

Adolescent↗
PubMed1996

[Epidemiology of individual front tooth gaps in exiled Tamilians].

During the period from 1986 to 1993, 254 Tamilian patients were examined by the Department of Public Health at Wuppertal. These patients had come from Sri Lanka as refugees applying for political asylum in the Federal Republic of Germany. In more than 60% of the patients isolated front tooth gaps were observed, an incidence that was significantly higher than in a control group of asylum seekers from countries other than Sri Lanka, and much higher than the incidence of traumatic tooth loss reported in the literature. To the authors the aetiology of this tooth loss remains largely unexplained, since the bulk of the medical histories given by the patients did not correlate with clinical and x-ray evidence. Considering that medical and especially dental causes for the loss of the teeth can be excluded, social, cultural, religious, or even political causes may be responsible for this anomaly.

Adolescent↗
PubMed2000

Functional human T-cell immunity and osteoprotegerin ligand control alveolar bone destruction in periodontal infection.

Periodontitis, a prime cause of tooth loss in humans, is implicated in the increased risk of systemic diseases such as heart failure, stroke, and bacterial pneumonia. The mechanisms by which periodontitis and antibacterial immunity lead to alveolar bone and tooth loss are poorly understood. To study the human immune response to specific periodontal infections, we transplanted human peripheral blood lymphocytes (HuPBLs) from periodontitis patients into NOD/SCID mice. Oral challenge of HuPBL-NOD/SCID mice with Actinobacillus actinomycetemcomitans, a well-known Gram-negative anaerobic microorganism that causes human periodontitis, activates human CD4(+) T cells in the periodontium and triggers local alveolar bone destruction. Human CD4(+) T cells, but not CD8(+) T cells or B cells, are identified as essential mediators of alveolar bone destruction. Stimulation of CD4(+) T cells by A. actinomycetemcomitans induces production of osteoprotegerin ligand (OPG-L), a key modulator of osteoclastogenesis and osteoclast activation. In vivo inhibition of OPG-L function with the decoy receptor OPG diminishes alveolar bone destruction and reduces the number of periodontal osteoclasts after microbial challenge. These data imply that the molecular explanation for alveolar bone destruction observed in periodontal infections is mediated by microorganism-triggered induction of OPG-L expression on CD4(+) T cells and the consequent activation of osteoclasts. Inhibition of OPG-L may thus have therapeutic value to prevent alveolar bone and/or tooth loss in human periodontitis.

Adult↗
PubMed1977

Calculus removal and loss of tooth substance in response to different periodontal instruments. A scanning electron microscope study.

The efficiency of calculus removal and the amount of lost tooth substance resulting from the use of hand curette, ultrasonic curette and rotating diamond and Roto-Pro points were examined by scanning electron microscopy (SEM). Root surfaces of mandibular incisors placed in a jaw model were cleaned of adhering deposits, photographed by SEM and evaluated at a standard magnification by three examiners. Scores were given for remaining calculus (RCI) and loss of tooth substance (LTSI) according to defined index criteria. The results revealed that calculus removal was most complete following diamond instrumentation, whereas the ultrasonic curette was least efficient in this respect. Hand curette, ultrasonic curette and Roto-Pro removed about the same amount of tooth substance whereas the diamond removed considerably more than the others. The diamond regularly removed all the cementum and left deep instrumental marks in the dentin; it seems advisable to avoid the use of such instruments in periodontal depuration.

Curettage↗
PubMed1999

Periodontal and dental lesions in raccoons from a farming and a recreational area in Illinois.

Dental health was evaluated in two populations of raccoons (Procyon lotor) in western Illinois (USA); one was from a rural agricultural area with low human density and the other from a nearby state park heavily used by humans and raccoons. From 1989 through 1993, 300 raccoons were live-trapped in the agricultural area and 246 raccoons were live-trapped in the park. Oral health was assessed using gingival and calculi indices and by measuring loss of attachment and tooth wear. Raccoons from the park were significantly older and smaller, but not thinner, than raccoons from the farmed area. Gingival and periodontal indices, tooth wear, tooth loss, and caries increased significantly from juveniles to yearlings to adults, at both sites. Males had higher levels of gingivitis and loss of periodontal attachment than females, but were similar on other dental measures. There were no seasonal differences between raccoons in dental indices. Animals with high scores for one oral measure tended to have high values for all indices. Dental health was generally good for juveniles and yearlings from both sites. Among adults, periodontal indices and the prevalence of caries were significantly higher in the park, but prevalence of broken or missing teeth was similar for both populations. There was no association between body condition, and a higher dental score or more missing or broken teeth.

Age Factors↗
PubMed2001

Longitudinal periodontal tissue alterations during supportive therapy. Findings from subjects with normal and high susceptibility to periodontal disease.

AIM: The aim of the study was to evaluate disease progression during supportive periodontal therapy in (i) a group of 225 subjects with "normal" (NG) and (ii) a group with high susceptibility (HSG; n= 109) to periodontal disease (based on their baseline disease status). MATERIAL AND METHODS: The following variables were recorded at the baseline examination (1 year after they received non-surgical periodontal therapy) and at the re-examination after 12 years of maintenance: number of teeth, plaque, probing pocket depth, probing attachment level, bone level in full mouth radiographs. All assessments were performed in a standardized manner and by well-trained and calibrated examiners. Supportive periodontal therapy was delivered 3-4 x per year and included repeated oral hygiene instruction and debridement. In addition, sites that bled on probing and had a PPD value of > or = 5 mm received subgingival instrumentation. RESULTS: A comparison between the findings at baseline and after 12 years revealed that in the NG, most subjects maintained their periodontal condition unchanged during the maintenance period; only a few subjects experienced tooth loss and the figures describing the mean amount of bone and attachment loss were small (0.5 mm and 0.3 mm respectively). The HSG patients experienced some tooth loss and also lost significant amounts of bone and attachment during the 12 years of SPT. Thus, in this group of subjects, the mean overall PAL loss amounted to 0.8 mm, i.e., 0.06 mm/tooth surface/year. In the NG, the overall attachment loss was significantly smaller: 0.5 mm, i.e. 0.04 mm/tooth surface/year. CONCLUSION: In subjects with a high susceptibility for periodontal disease who had been treated for this condition by non-surgical means, an SPT program including regularly repeated oral hygiene instruction and subgingival debridement, made it possible to maintain bone and attachment levels at a reasonably stable level over a 12-year period. A similar SPT provided to a group of subjects with normal susceptibility to periodontal disease, on the other hand, prevented almost entirely major tooth, bone and attachment loss.

Adult↗
PubMed2001

Epidemiology of periodontal disease: a review and clinical perspectives.

The purpose of this paper is to assimilate epidemiological evidence for the prevalence of periodontal disease in human populations, and for comprehensive understanding of the disease for health care providers. Periodontal disease is a pathological condition affecting the supporting structures of teeth. It is characterised by a bacterial challenge that can instigate a destructive host response leading to periodontal attachment loss, bone loss and ultimately, possible tooth loss. The specifics of the disease process are obscured by our incomplete understanding of the role of various risk factors. Periodontal epidemiology literature lacks consistency in methodology of research, which includes various definitions for periodontal disease and health; different approaches to measuring periodontal indices of pocket depth, and attachment loss; inconsistent study designs and lack of adjustments to known risk factors. These inconsistencies do not allow for effective comparison of epidemiological studies, which is essential to find strong associations of risk factors with periodontal disease, which in turn is necessary for the interpretation of risk and causality. This paper will address several areas within the topic of periodontal disease epidemiology, including definitions of periodontal disease instituted by researchers, approaches to epidemiological studies in periodontitis, and risk factors in periodontal disease. Consideration is given to aspects of design and analyses relevant to evaluation of reports in the literature. For the clinical practitioner this review provides a theoretical framework to approach patients with comprehensive knowledge of not only the disease presentation, but also the environmental factors that govern past history, present condition and future response to treatments and interventions.

Alveolar Bone Loss↗
PubMed1989

Dental pathologies in ten free-ranging chimpanzees from Gombe National Park, Tanzania.

The dental remains of ten adult chimpanzees from Gombe National Park, Tanzania, were examined for enamel attrition, caries, abscesses, periodontal disease, and tooth loss. Age was the underlying factor in the development of dental pathology, in that enamel wear was present to some extent in all ten but was uniformly severe only in the three for whom estimated age at death was 39-43 years. In turn, enamel wear appears to have been the direct cause of abscess development, periodontal disease, and tooth loss. Periodontal disease was commonly expressed as alveolar resorption, particularly around the premolars and molars. This involvement was variable in all except the two youngest. Some interesting wear patterns were evident in the form of deep grooves in the upper incisors and dramatic notching of the lower canines. These patterns, and enamel attrition in general, were attributed to normal mastication and to various stripping activities. Only one carious lesion was observed, in a male with an estimated age of 26 years. An accurate assessment of the actual prevalence of caries was obscured by enamel wear and tooth loss in the older individuals.

Age Factors↗
PubMed2000

Influence of diet and occlusal support on learning memory in rats behavioral and biochemical studies.

In order to verify the relationship between tooth loss and the learning memory in rat, male Wistar rats (25 weeks old) were divided into three separate groups: a control group (fed with a solid diet); a soft diet group (fed with a powder diet containing the same components as the solid one) and a molarless group (all molars were removed at 25 weeks and then fed with a powder diet). To evaluate both learning ability and memory, rats were tested with a one-way step through type of passive avoidance apparatus divided into light and dark chambers at 40-weeks. After the passive avoidance test, determination of acetylcholine (ACh) concentration of the cerebral cortex and hippocampus was performed. There was no significant difference between the molarless group and the control group in the response latency before the acquisition trails (non-stimulated period). At day 4 and 7 after the acquisition trials, the response latency of the molarless group was significantly shorter than that in the control group (p<0.05). The ACh levels of the molarless group in the cerebral cortex and hippocampus were significantly lower than that of the control group (p<0.05). It was apparent that tooth loss had an association with a loss of discriminative learning ability. This study suggested that the decrease of masticatory function caused by tooth loss leads to a decrease of ACh synthesis resulting in a learning memory disorder.

Acetylcholine↗
PubMed2005

Risk determinants of periodontal disease--an analysis of the Study of Health in Pomerania (SHIP 0).

BACKGROUND: In this study, risk determinants were determined for periodontal disease in the representative population sample (n=3146) of the Study of Health in Pomerania. METHODS: After examining the net random sample (response 69%) and exclusion of edentulous cases and those with missing values, 2595 subjects remained. Using a multivariate, fully adjusted logistic regression, different definitions of "periodontally diseased/healthy" were examined as the dependent variable (extent of attachment loss (AL> or =4 mm, combined AL and tooth loss). The independent variables used were sociodemographic factors (age, gender, income, education), medical factors (systemic diseases, drugs), behavioral factors (regular dental checkup, smoking), and oral factors (presence of supragingival calculus and plaque). RESULTS: The following risk determinants were found for AL: male gender, presence of supragingival plaque and calculus, smoking, low educational level. For the combination of AL and tooth loss, risk determinants were female gender, supragingival plaque, smoking, and low educational level. Consumption of antiallergic medications and regular dental checkups proved to be protective. Smoking was the most influential risk determinant. These parameters explained approximately 43-55% of the variation. CONCLUSION: These results concur with those of the literature. In order to explain disease status further, host-response and microbiological factors must also be examined.

Adult↗
PubMed2003

Untreated periodontal disease: a follow-up on 30 cases.

BACKGROUND: Many studies have shown that periodontal disease can be successfully treated. However, there is limited documentation as to what happens when periodontal disease is left untreated. This study examined patients in a private practice who were diagnosed with periodontal disease and did not complete any treatment. The goal was to see what happened to this group of untreated patients. METHODS: Thirty patients with periodontal disease were included in this study. After a mean period of 2.1 years without periodontal treatment, the patients were re-examined and the changes which occurred evaluated. RESULTS: There was a statistically significant increase in probing depth (3.43 mm to 3.95 mm) and attachment loss (4.19 mm to 4.77 mm) and a statistically significant decrease in the number of teeth present (23.37 to 22.67). Twenty-one teeth were lost, which was 3.0% of the teeth present at the time of initial diagnosis. The rate of tooth loss was 0.32 teeth/patient/year. The teeth that were lost had deeper recession, probing depths, and attachment loss than the teeth that were retained. Patient factors evaluated could not be associated with statistically significant changes in the clinical parameters, except that smokers had a greater number of sites gaining > or = 2 mm of attachment and patients with the poorest oral hygiene had a greater percent of sites breaking down. However, certain site specific variables could be associated with statistically significant changes in the clinical parameters. These included sites: with bleeding on probing, associated with molar furcations, on interproximal surfaces, at posterior teeth, with probing depths > or = 3.43 mm, with probing depths > or = 7 mm, attachment loss > or = 7 mm, and teeth with increased mobility. CONCLUSIONS: This group of patients with untreated periodontal disease had greater breakdown and tooth loss than one would expect to see in a group of patients if their periodontal disease was treated.

Adult↗
PubMed2004

Removable prostheses for preschool children: report of two cases.

Dental prostheses are frequently used to avoid psychologic, speech, or swallowing problems in preschool children with considerable tooth loss. Two cases of preschool children are presented, involving multiple loss of primary teeth. The purpose of this study was to promote the correct development of the maxilla and mandible by using removable dental prostheses and to guide the eruption of the permanent molars. Removable acrylic prostheses were provided for two children, with a special metallic s-shaped handle (ansa), which guided the eruption of the first permanent molars. These prostheses were modified as the children grew. By replacing missing teeth, several oral functions were re-established, development of the maxilla and mandible was promoted, and each child could develop socially from a psychologic point of view. The use of removable dental prostheses in preschool-aged children presenting with considerable tooth loss can be a viable and successful treatment option.

Child, Preschool↗
PubMed1996

Missing teeth and lost teeth of adults aged 30 years and over in south-western Finland.

The majority of Finnish adults have lost one, some or all of their teeth. The prosthetic replacement of missing teeth has thus been an important element of adult dental care. However, there have been no longitudinal studies focusing on the development of oral health among the Finnish adult population in terms of further tooth loss. A baseline sample from 1977-78 was selected from the city of Turku to represent the adult population aged 30 years and over. Ten years later, a follow-up examination was carried out on this baseline study group. A new sample of persons aged 30-39 years was also obtained to provide cross-sectional information, allowing comparisons between this study group and the youngest age-group of the 1977-78 study. In 1977-78, 52 per cent of all subjects had 20 or more remaining teeth. The mean number of missing teeth was 15.8 (SD 11.05) and the corresponding median 12 teeth. The number of missing teeth was on average higher in the older age-groups (P < 0.001). Women had more missing teeth than men (P < 0.01). In the ten-year follow-up study, the mean number of lost teeth was 1.5 (SD 2.32) and the median one tooth. The average number of lost teeth increased with age (P < 0.01). The rate of tooth loss was highest for those with 10 to 19 teeth at baseline, second highest for those with one to nine teeth and lowest for those with 20 to 32 teeth (P < 0.001). The reasons most often reported for tooth extraction were tooth mobility, pain and prosthetic treatment. In the cross-sectional study groups of persons aged 30-39 years, the proportion of subjects with a complete natural dentition of 28 to 32 teeth was 63.4 per cent in 1989, compared with 40.0 per cent ten years earlier. The average number of missing teeth was lower in 1989 than in 1977-78 (mean 4.7, SD 3.81 vs. mean 7.8, SD 6.92; P < 0.001). In both cross-sectional examinations women had a higher mean number of missing teeth than men. However, the difference between the genders was statistically significant only in 1977-78 (P < 0.01). Among the age-group of 30-39 years, there has been a considerable improvement in retention of natural teeth during the ten-year interval. However, among the middle-aged and elderly population reduced dentition was common; in addition, extraction was still used as a dental treatment especially among persons with reduced dentition. This suggests that the need for prosthetic replacement of lost teeth will continue to play a role in adult dental care in Finland for some decades to come.

Adult↗
PubMed2002

The relationship between oral conditions and ischemic stroke and peripheral vascular disease.

BACKGROUND: This article is a critical review of the epidemiologic studies linking or disassociating oral conditions with stroke and peripheral vascular disease, or PVD. It also describes possible causal and non-causal pathways for these associations. TYPES OF STUDIES REVIEWED: The author reviewed studies that evaluated the oral conditions of periodontal disease or tooth loss as risk factors for arterial disease and stroke. RESULTS: Seven of nine studies evaluating tooth loss and periodontal disease as risk factors for stroke or PVD showed some significant associations. The studies varied in the exposures and outcomes evaluated; therefore, the associations were not consistently replicated. It is unclear whether the associations found between these oral conditions and cardiovascular disease had any causal component. In the absence of any causal relationship, the associations may be explained by common risk factors. Alternatively, there may be a causal relationship that may be explained by one or more potential causal pathways. Further epidemiologic studies are needed, and the role of nutrition and other inflammatory mediators needs to be explored further in this context. CLINICAL IMPLICATIONS: It is recommended that clinicians continue to provide standard professional care, as well as nutritional counseling to help patients maintain a healthy diet after extractions. Clinicians are cautioned against suggesting extractions as a means of preventing cardiovascular disease.

Humans↗