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PubMed1991

A study of the reasons for tooth extraction in a Canadian population sample.

The reasons for extraction of teeth were determined in a Canadian population sample of 909 patients, ranging in age from 14 to 91 years. Caries was the primary cause of extraction (63%), followed by periodontitis (34%). For the adult age groups, the percentages were approximately the same. While periodontitis was the cause of one-third of the extractions, these occurred in only one-fifth of the population. Although there is a commonly expressed belief that periodontitis is the major cause of tooth loss in adults, a review of both historical and contemporary literature does not support this position. According to the current concept of the natural history of periodontal disease, only about one-fifth of the population, or less, is likely to have periodontitis severe enough to cause tooth loss. This view is consistent with data from this and most other studies on the reasons for tooth extraction.

Adolescent↗
PubMedDate not supplied

Localized prepubertal periodontitis: literature review and report of case.

This case describes a young, healthy, white female who demonstrated anterior alveolar bone loss along with premature loss of her primary incisors. The alveolar bone loss remains unexplained. The root surfaces of most of the primary anterior teeth exhibited one or more eroded areas devoid of cementum with some evidence in two teeth of cellular resorptive activity. These findings suggest that premature root resorption was occurring concurrently with unexplained extensive alveolar bone loss. The child will be examined periodically to determine whether this process of bone loss with subsequent tooth loss will involve additional primary or permanent teeth.

Aggressive Periodontitis↗
PubMed1995

Tobacco use and dental disease.

The previously cited Indiana University School of Dentistry teaching monograph, "The Impact of Tobacco Use and Cessation on Nonmalignant and Precancerous Oral and Dental Diseases and Conditions," reviewed over 800 articles and concluded that tobacco use is strongly associated with many dental and oral mucosal diseases, and may contribute to others. Our study of a relatively small sample of 200 patients, of whom 33 percent were tobacco users, found statistically significant data correlating tobacco use with a higher Decayed, Missing and Filled Index (a measurement of caries and tooth loss experience of patients) and relating periodontal bone loss to smokeless tobacco use. And, while this investigation did not find a statistically significant correlation between smoking and periodontitis severity, there was a data trend in that direction. Conclusions about tooth loss in the Indiana monograph were limited to smokers; however, there was an association of ST use with gingival recession, which can become quite severe in the area in which the smokeless tobacco is placed. It might be theorized that the significantly larger number of missing teeth among ST users in our study is associated with the generally poor oral hygiene and less sophisticated outlook on health care that tobacco users often display. Indeed, of the 65 denture wearers in our study, 7.7 percent were ST users and 40.0 percent were tobacco users of some type. In view of the large amount of data in the scientific literature associating tobacco with dental diseases as summarized by the Indiana monograph, and the position of several groups such as the American Cancer Society that tobacco is one of the risk factors most associated with intraoral cancer, it would appear that dentists have a vested professional interest in promoting tobacco use cessation among their patients. Dentists should take every reasonable opportunity to persuade patients to discontinue the tobacco habit, thus preventing life-threatening malignancies as well as dental diseases.

Adolescent↗
PubMed2004

Enamel matrix derivative for periodontal tissue regeneration in treatment of intrabony defects: a Cochrane systematic review.

We reviewed the literature on the efficacy of enamel matrix derivative (EMD) in comparison with open flap debridement, guided tissue regeneration (GTR), and bone grafting for the treatment of intrabony defects. We searched four major electronic databases for randomized controlled trials (RCTs) with at least one year of follow-up. Several journals were handsearched with no language restrictions. Outcome measures were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), marginal bone levels on intraoral radiographs, and postoperative infections. Screening of eligible RCTs, assessment of the methodological quality, and data extraction were conducted in duplicate. No difference in tooth loss was observed. A meta-analysis (eight trials) showed that EMD-treated sites displayed statistically significant PAL improvements (mean difference 1.3 mm) and PPD reduction (1 mm) when compared to flap surgery. When EMD was compared to GTR (six trials), GTR showed a statistically significant reduction of PPD (0.6 mm) and increase of REC (0.5 mm). No difference in postoperative infections was observed. No trials compared EMD with bone grafts alone. EMD is able to significantly improve PAL levels and PPD reduction when compared to flap surgery; however, there is no evidence that more teeth could be saved. There was no evidence of important differences between EMD and GTR.

Alveolar Bone Loss↗
PubMed2002

Social and behavioral correlates of oral quality of life studied among university students in Tanzania.

This study applies an abbreviated version of the Oral Impacts on Daily Performances (OIDP) and the Life Satisfaction scale to oral-health-related quality of life (OHRQOL) and quality of life (QOL) among Tanzanian university students. The following questions were addressed: Are social and behavioral status associated with overall OIDP frequency scores? Do social and behavioral variables contribute to the explainable variance of the OIDP frequency scores beyond the effect of clinical indicators of oral disorders? Do OIDP frequency scores influence general QOL as measured by the Life Satisfaction scale? A two-wave cross-sectional study was conducted during the summer of 1999, involving 19-45-year-old students at the University of Dar es Salaam. One-thousand-one-hundred-and-twenty-three students completed self-administered questionnaires and 228 respondents were re-examined clinically after 4 weeks. The rates of tooth decay and tooth loss were 34% and 37%, respectively. Medical-non-medical status (OR = 2.7) self-perceived health status (OR = 2.7), and sugar avoidance (OR = 2.2) varied systematically with OIDP scores in multivariate analyses. Tooth decay and tooth loss alone contributed 10% to the explainable variance in the OIDP scores. Entering social and behavioral variables increased the explainable variance to 19%. Finally, life-satisfaction scores varied systematically and positively with the OIDP frequency scores in bi- and multivariate analyses. This study gives some indications that the social and behavioral contexts of Tanzanian university students are important in shaping their responses to oral disorders.

Activities of Daily Living↗
PubMed2004

Long-term tooth survival following regenerative treatment of intrabony defects.

BACKGROUND: The longevity of the clinical benefits of guided tissue regeneration (GTR) has not been fully explored. The aim of this investigation was to assess the long-term survival of GTR treated sites in terms of clinical attachment level (CAL) stability and tooth loss. METHODS: A total of 175 patients with one deep intrabony defect were selected for a retrospective investigation of tooth retention and CAL stability. All sites had been treated with GTR more than 2 years previously and had received full periodontal examinations every 2 years for up to 16 years. Definitions of events for survival analyses were tooth loss, loss of > or = 2 mm compared with the CAL observed before GTR treatment, and loss of > or = 2 mm compared with the CAL observed 1 year after completion of GTR. RESULTS: Teeth were severely compromised by the presence of CAL loss of 10.7 +/- 2.4 mm, probing depths of 8.7 +/- 2.3 mm and deep intrabony defects (average depth 6.6 +/- 2.1 mm). After GTR, CAL gains were 4.6 +/- 2 mm. Average follow up was 8 +/- 3.4 years; 66.9% of subjects strictly complied with a periodontal maintenance program. Tooth survival was greater than 96% more than 10 years after GTR. CAL was equal or coronal with respect to pretreatment in 92% of cases followed for 15 years after treatment, while loss of CAL compared to the 1-year post-GTR result was observed in 37.8% of cases. Cox proportional hazard models indicated that incidence-free survival was negatively affected by smoking and positively affected by full compliance with a periodontal maintenance program in a specialist practice. CONCLUSIONS: Within the limits of this study, data suggest that tooth retention and clinical improvements following GTR treatment of intrabony defects can be maintained long term in the great majority of cases and thus that regenerative periodontal treatment represents an important alternative for the management of severely compromised teeth.

Adolescent↗
PubMed1989

Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents.

This longitudinal study monitored periodontal status in 20 adults and 20 adolescents undergoing fixed orthodontic treatment. Ten adults had generalized periodontitis and received periodontal treatment, including periodontal surgery, before orthodontic treatment. They also received periodontal maintenance at 3-month intervals during orthodontic treatment. The other 10 adults had normal periodontal tissues. Neither these latter adults nor the adolescents received periodontal maintenance during orthodontic treatment. Periodontal status was determined (1) at six standard sites before fixed appliances were placed (baseline), (2) at 1, 3, 6, 9, 12, and 18 months after appliances had been placed, and (3) 1, 3, 6, and 12 months after appliances had been removed. At each of these visits, these sites were assessed for plaque index, gingival index, bleeding tendency, and pocket depth. Loss of attachment between baseline and 3 months after appliances were removed and tooth loss were also determined. Complete data were obtained for 15 adolescents and 14 adults. During orthodontic treatment the adolescent group showed significantly more (p less than 0.05) periodontal inflammation and supragingival plaque than the adults; after appliances were removed, this pattern was no longer statistically significant. For loss of attachment, there were no significant differences among adolescents, adults with normal periodontal tissues, or adults with reduced but healthy periodontal tissues who had undergone treatment for periodontal disease. For tooth loss, three nonstudy site teeth with pockets deeper than 6 mm and/or furcation involvements were lost because of periodontal abscesses in the adult group treated for periodontal disease.

Adolescent↗
PubMed1994

Association between clinical and subjective indicators of oral health status in an older adult population.

Since the mid-1970s a number of investigators have developed measures of the extent to which oral disorders compromise functional, social and psychological well-being. They have also examined the associations between clinical indicators of oral health status and these subjective indicators. In general, these associations have been inconsistent and weak. One reason for this might be that the subjective indicators employed were rudimentary and insensitive to the health outcomes of oral disorders. The development of the Oral Health Impact Profile, a more sophisticated measure of the health outcomes of oral disorders, provided a method to examine this hypothesis. Using data from an oral health survey of older adults, we examined the associations between OHIP scores and a variety of clinical indicators of tooth loss, caries and periodontal disease. Even with this measure the associations were predominantly weak, the strongest of the correlations being 0.53. We also examined the influence of personal and sociodemographic characteristics on the relationship between tooth loss and its psychosocial outcomes. Five variables reflecting expectations and resources explained as much variance in OHIP scores as did the number of missing teeth. This analysis illustrates the essential distinction between disease and health and the way in which measures of oral health can be used to pursue fundamental issues in behavioural science and health services research.

Aged↗
PubMed1993

Prevalence and technical standard of endodontic treatment in a Swedish population. A longitudinal study.

The aims of this thesis were to study longitudinally the tooth mortality, prevalence and technical standard of endodontic treatment as well as the endodontic treatment need in a Swedish population. Furthermore, the prevalences of teeth with crowns and posts were studied as well as the prevalence of apical periodontitis in such teeth, to see if these treatments affected the apical status. Finally, the reasons for and incidence of tooth mortality were investigated to see if the reasons for extractions were correlated to endodontic status, crown or post therapy, respectively. The interobserver variation between the two observers taking part in the investigation was also studied and found to be acceptable. The material consisted of full mouth radiographic surveys from 200 patients examined twice with an interval of 5-7 years. It was found that tooth losses were evenly distributed in the different age-groups and that molars were lost more often than teeth in the frontal region. Furthermore, endodontically treated teeth were lost more often than other teeth and the quality of the root filling affected the risk of tooth losses. Teeth with screw posts were lost more frequently than other teeth, while crowned teeth did not run a higher risk of being lost than teeth without crowns. Caries, including pulpitis and apical periodontitis, was the main reason for tooth extractions. There was a great need for endodontic treatment in the population examined, and the technical standard of the root fillings was poor. A slight improvement in quality of endodontic treatment was evident at the second examination. However, the technical standard was still poor. It is concluded that it is important that dentists in general practice should be better trained in performing endodontic treatment, and that research efforts should be made to find better and simpler methods for endodontic treatment.

Adult↗
PubMed2002

Middle Pleistocene human remains from the Bau de l'Aubesier.

Excavations in later Middle Pleistocene levels at the Bau de l'Aubesier, Vaucluse, France yielded a maxillary molar (M(1) or M(2); Aubesier 10) and a partial mandible from the left C(1) alveolus to the right condylar base lacking the coronoid process (Aubesier 11). Dentally they are similar to other later Middle Pleistocene Europeans in dental dimensions and variable taurodontism (Aubesier 10 but not Aubesier 11). The small Aubesier 11 mandible exhibits a retreating symphyseal profile with a minimal tuber symphyseos, an anterior marginal tubercle at P(4)/M(1), the mental foramen at P(4)/M(1)-M(1), a modest retromolar space, no lingular bridging of the mandibular foramen, an enlarged superior medial pterygoid tubercle, a modest lateral condylar tubercle, and a mandibular notch crest that intersects the middle third of the condylar margin. All of these features fall within the ranges of variation of later Middle Pleistocene Neandertal lineage humans, and some are characteristic of Middle Pleistocene human mandibles in general. In addition, Aubesier 11 exhibits pervasive ante mortem alveolar resorption with apical abscesses, alveolar bone destruction, universal labial/buccal bone loss, ante mortem tooth loss (for > or =81.8% of preserved alveoli), a lingual alveolar fenestration, and two broken root apices with masticatory attrition. These lesions indicate significantly impaired masticatory function, the oldest specimen currently known with such a reduced degree of dental function but one of several Middle Pleistocene human remains with indications of serious abnormalities.

Alveolar Bone Loss↗
PubMedDate not supplied

A review of localized juvenile periodontitis (LJP): II. Clinical trials and treatment guidelines.

Localized juvenile periodontitis (LJP) causes severe alveolar bone loss and early tooth loss in adolescents and young adults. If it is not appropriately treated as an infection in association with Actinobacillus actinomycetemcomitans, treatment failure is likely. This review of clinical trials of treatment of LJP uses those trials to construct guidelines for LJP treatment.

Actinobacillus Infections↗
PubMed2004

Dental nomograms for benchmarking based on the study of health in Pomerania data set.

AIM: Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles. MATERIAL AND METHODS: The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20-79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram. RESULTS: In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth. CONCLUSION: The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or--as in the case of the special care unit--public health research.

Adult↗
PubMed2002

Osteoporosis: a review and its dental implications.

Osteoporosis is a disease that affects primarily women, but can also occur in men. It is characterized by a loss of bone mineral density (BMD), and often culminates in a fracture of the hip, wrist, and/or vertebrae. The diagnosis of osteoporosis is often made by using bone density measurements. They are often expressed in relative terms (T-scores and Z-scores); the Z-score is the number of standard deviations from the age-matched average value of healthy women. A low Z-score indicates the bone density is lower than it should be for a patient's age and sex. Osteoporosis is defined as a BMD loss of 2.5 standard deviations or more below the established mean. Osteoporosis can be treated by a variety of methods, the most common being the use of estrogen, with or without progestin or progesterone. The use of estrogen alone is referred to as estrogen replacement therapy (ERT), and the combination hormone replacement therapy (HRT). Other drugs used in the treatment of osteoporosis are the selective estrogen receptor modulators (SERMs) and the bisphosphonates. The SERMs appear to offer many of the positive benefits of estrogen with fewer adverse effects on the breast or uterus. Recently, a randomized, double blind study of nearly 3,000 women found no overall benefit in reducing heart disease for those taking estrogen. In fact, in the first year of estrogen use, heart disease was higher in this group than in those taking placebo. The relationship between systemic BMD and periodontal status has been investigated. In some patients, there is a correlation between a decrease of mandibular bone mass and tooth loss. In others, there is no such correlation. Those postmenopausal women taking HRT had greater tooth retention and a reduced likelihood of edentulism. A recent study has found no correlation between clinical attachment levels and the BMD of the lumbar spine. Many possible factors contribute to the development of osteoporosis and periodontal diseases. It is difficult to establish a direct correlation between tooth loss, bone loss, and loss of attachment resulting from periodontitis and decreased BMD associated with osteoporosis, but studies are ongoing.

Aged↗
PubMed2002

Factors affecting degeneration in human temporomandibular joints as assessed histologically.

The influence of sex, age, tooth loss, and articular disc position on temporomandibular joint (TMJ) degeneration was evaluated in specimens collected at autopsy from 15 women and 38 men ranging in age from 15 to 92 yr. The position of the articular discs was classified as normal or abnormal, tooth loss was both counted and categorized. Degenerative changes of the articular tissues were assessed histologically and quantified, taking into account both the severity of structural alterations and their extension along the articular surface. This was recorded separately in the condyle, disc, and temporal component, three latero-medial joint regions, and putative load-bearing and non-load-bearing surfaces. Analysis of covariance with repeated measures served for testing contributing factors. It showed that the effects of sex and the number of missing teeth were insignificant, whereas age up to about 55-60 yr and reduction of dental arch length proved to be the most important factors. Load-bearing seemed to play a significant role mainly at younger ages, and the effect of disc position was significant, when internal derangement was combined with reduction of dental arch length. Thus, rising severity of TMJ degenerative changes appears to be associated primarily with increasing age. In addition, it may also depend on mechanical factors, in particular loss of molar support and, to a minor degree, abnormal disc position.

Adolescent↗
PubMed1991

Long-term evaluation of surgical periodontal treatment with and without maintenance care.

A study was conducted on the effectiveness of individual maintenance recalls and the long-term effects of surgical therapy on pocket depth and tooth loss in 43 patients with moderate to advanced periodontal disease. Sixteen of the patients had periodic control and 27 were uncontrolled. Intervals of periodic recall ranged from 3 to 6 months according to individual needs. Pocket depths were measured from four aspects of each tooth and initially classified as shallow (1-3 mm), moderate (4-6 mm) or deep (7 mm or more). Changes in each pocket depth level were determined after 10 years. Tenth-year comparisons showed that the uncontrolled group had significantly higher mean pocket depth values. Tooth loss rate was 3.6% in the controlled group, and 14.1% in the uncontrolled group, and the mean numbers of lost teeth were 0.69 and 3.63, respectively, in the ten-year period. It was concluded that periodic recalls were essential for long-term success of periodontal surgery.

Adult↗
PubMed2005

Overeruption--another challenge?

UNLABELLED: Awareness of the occlusal changes following individual tooth loss may be increasingly important when planning treatment for patients who are likely to retain a relatively intact dentition throughout life. Some evidence exists to support dentists who are considering prevention or treatment of overeruption. This paper explores the literature available on the changes in the prevalence of tooth loss, the prevalence and presentation of overeruption, its relevance to dental restoration and the prevention and treatment of overeruption. CLINICAL RELEVANCE: This article reviews the prevalence and consequence of overeruption in posterior teeth.

Dental Occlusion↗
PubMed2005

Morphometric difference in the human maxillary nerve fibers between dentulous and edentulous jaw subjects.

This study was conducted to quantify the change in the number and size of myelinated nerve fibers of the maxillary nerve with tooth loss in humans. We carried out a morphometric analysis to compare the number and size of myelinated nerve fibers in the human maxillary nerve between four dentulous and four edentulous jaw cases. Our results indicated that the number of axons decreased by approximately 13,000 with tooth loss. The average size of axons remained unchanged, but there was a change in the fiber size distribution, namely the loss of a large number of small-sized axons was accompanied by the total disappearance of small number of large-sized axons.

Aged↗