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PubMed1992

Improving dental epidemiologic data collection with computers.

A computerized dental data recording system (DDRS) was developed for the New England Elder Dental Study to improve data quality and increase field staff efficiency. The DDRS displays video screens similar to traditional paper forms to record data on coronal and root caries, dentate and denture status, subacute bacterial endocarditis screening, gingival bleeding, calculus, and periodontal attachment level. DDRS provides facilities for date and exam-component time tracking, on-line contextual comments, random record retrieval, editing, data backup, and data output in various data formats. This study compared the DDRS with a paper-form system for data entry accuracy. Dental caries and periodontal disease measurement data from 38 subjects were recorded on paper forms and independently entered using DDRS. The DDRS identified 150 illogical data errors, 39 inconsistent data errors, 7 invalid data and 34 miscellaneous data errors. Four technicians with field experience using both paper forms and DDRS reported time savings using DDRS in the field. DDRS has the potential for additional time savings by minimizing the time for data coding, cleaning, and management. Results demonstrate that DDRS could improve the quality of oral epidemiologic data by mandating strict adherence to protocols, preventing errors, and increasing field efficiency.

Computers↗
PubMed1999

Oral health and microflora in an institutionalised elderly population in Canada.

A cross-sectional study was undertaken to assess the oral health of a group of elderly, long-term care, institutionalised residents in a facility in Edmonton, Canada. In addition, the oral occurrence of Candida and coliform micro-organisms was evaluated to examine the relationship between oral health status and oral prevalence of these opportunistic pathogens. The mean age of 63 examined individuals was 83.4 (+/- 17.6) years; 28.6 per cent were dentate with a DMF score of 22.4; 4.5 per cent of teeth exhibited root caries. Of the edentate, 55.5 per cent were wearing complete maxillary and mandibular dentures; 59 per cent of the maxillary dentures and 20 per cent of mandibular dentures were found to exhibit good retention and stability while the remaining prostheses were deemed to be poor; 17 per cent of individuals had neither teeth or dentures. Denture stomatitis was the most common mucosal lesion and was found amongst one third of the denture wearers. Three quarters of the residents harboured oral yeasts, 30 per cent coliforms and a significant number exhibited poor oral hygiene and oral pathoses for which remedial treatment was readily available in the form of subsidised dental care.

Aged↗
PubMed1994

Effects of a supersaturated pulpal fluid on the formation of caries-like lesions on the roots of human teeth.

Root surfaces were exposed to demineralizing buffer in a continuous-flow system, with or without simultaneous perfusion of the pulp chamber with a supersaturated surrogate dentine fluid (SDF). Experimental lesions formed with perfusion of the pulp were significantly less deep than control lesions formed without perfusion, but the application of hydrostatic pressure to the SDF (15 or 30 cm water) did not produce significantly greater reductions. The lesion depth reduction was attributed to reduced undersaturation at the advancing lesion front through interdiffusion of the demineralizing buffer and the SDF. Translucent bands, resembling sclerotic dentine, were observed beneath 9 of 24 experimental lesions and 5 of 24 control lesions. Scanning electron microscopy showed that, in most of the bands beneath experimental lesions, dentinal tubules were either partly occluded by granular mineral deposits or were reduced in diameter. Thus, in vivo, dentine fluid may modify the rate of lesion progression and promote sclerosis in the underlying dentine.

Acetates↗
PubMed1991

Geriatric dentistry and prevention: research and public policy.

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral disease. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Geriatric dentistry and prevention: research and public policy (reaction paper).

The population of older adults is heterogeneous and can be divided into many subgroups: the young-old, the old-old, the healthy, the sick, the frail, the mentally and physically handicapped, the ambulatory, the chair-bound, house-bound or institution-bound, and the economically advantaged and disadvantaged. This diversity is extremely important to the discussion of the oral health needs, preventive health strategies, and research agenda for the elderly. As life expectancy increases, more attention is being paid to disease prevention so that the quality of life in old age can be improved. However, the link among oral health, systemic disease, and quality of life in the elderly needs to be better-defined. There is some evidence in the literature that indicates that coronal and root caries appear to be major health problems for the elderly. This needs to be corroborated in longitudinal studies. Although periodontal disease prevalence and severity are high in some subgroups of the elderly, these appear to be in decline in the general population. Dental health-care workers must be cognizant of the oral conditions associated with systemic disease and the use of medication, a major concern in older adults. Prevention of oral disease in the elderly requires early intervention, education of the dental health team, and innovative uses of well-established preventive agents such as fluoride. An extensive research effort is needed to answer basic and applied questions regarding the oral health needs of the elderly. Federal and private funding will be necessary. The dental profession will have to demonstrate and be persuasive that money spent on research and care for the elderly is money well spent.

Aged↗
PubMed1997

Oral effects of smokeless tobacco use by professional baseball players.

This is a review of studies conducted from 1988-90 on the oral consequences of snuff and chewing tobacco use among professional baseball players. About half of the players studied were smokeless tobacco (ST) users, the majority of whom used snuff. Compared with non-users, players who used ST showed a significantly higher prevalence of leukoplakia, which was related to placement of the ST quid, and the frequency, amount, duration, and type of ST used. Sites adjacent to these mucosal lesions showed an increased prevalence of gingival recession with associated attachment loss, cervical abrasion, and root caries than did comparable sites in non-users. Extrinsic stain and occlusal attrition were also more frequent in ST users than in non-users. While ST use placed players at significantly increased risk for mucosal lesions and other oral problems, no differences were found between ST non-users and users in measurements of batting, fielding, and pitching performance during the baseball season.

Adult↗
PubMed1994

Orthodontic treatment and isolated gingival recession: a review.

Isolated gingival recession may occur in as many as 30 per cent of adolescents, and lead to problems of dentine hypersensitivity, root caries, and gingival inflammation in adult life. This review discusses the prevalence and aetiology of isolated recession, with particular reference to the implications for orthodontic treatment. Consideration is also given to the differing philosophies for management.

Adolescent↗
PubMed1999

Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994.

BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population.

Adult↗
PubMed1999

Type 1 diabetes mellitus and oral health: assessment of periodontal disease.

BACKGROUND: The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2-year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes. METHODS: During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, midcervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA). RESULTS: Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA > or =4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients. CONCLUSIONS: Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking.

Adult↗
PubMed2004

The effect of cigarette smoking on gingival bleeding.

BACKGROUND: The purpose of this study was to investigate the dose-dependent effect of cigarette smoking upon gingival bleeding on probing (BOP) in a large representative sample of the United States population (National Health and Nutrition Examination Survey III). METHODS: Weighted multiple logistic regression was used to model bleeding on probing of 141,967 mesio-buccal sites in 12,385 individuals with complete case records on all covariates. Adjustments were made for age, gender, race/ethnicity, number of missing teeth, tooth type/jaw, root caries, full crown coverage, socioeconomic status (poverty/income ratio), and survey characteristics. The model stratified by presence of calculus (CALC) and increased probing depth (PD > or = 4 mm). Generalized estimating equations were used to account for dependence of sites within subjects. RESULTS: Smoking had a strong suppressive effect on gingival bleeding. The effect was strongest in heavier smokers (> 10 cigarettes/day) and smallest in former smokers. In healthy sites (no CALC, PD < or = 3 mm), the odds ratio (OR) of bleeding for sites in heavier smokers compared to never-smokers was 0.56 (95% CI: 0.45-0.70). Sites with CALC and/or PD > or = 4 mm were more likely to bleed in never-smokers (OR: 5.7; 95% CI: 4.3-7.6). This relationship was less evident among heavier smokers (OR: 1.3; 95% CI: 0.8-1.9). The effect of smoking did not differ between maxillary and mandibular molars, premolars, or incisors. CONCLUSION: Smoking exerts a strong, chronic, and dose-dependent suppressive effect on gingival bleeding on probing.

Adolescent↗
PubMed1988

Incidence of tooth loss among elderly Iowans.

This study investigated the 18-month incidence of tooth loss in a random sample of 451 dentate noninstitutionalized Iowans aged 65 and older residing in two rural counties. They had a mean of 19.0 teeth at baseline and lost an average of 0.4 teeth during the subsequent 18 months. Twenty-one per cent of the population lost at least one tooth. Four people had all their teeth extracted. Of the teeth present at baseline, 1.9 per cent subsequently were extracted. The highest incidence of tooth loss occurred among mandibular molars (3.7 per cent), followed by maxillary premolars and canines (3.1 per cent each). The best predictors of tooth loss were previous coronal and root caries.

Aged↗
PubMed1997

Resin-ionomer and hybrid-ionomer cements: part II, human clinical and histologic wound healing responses in specific periodontal lesions.

Twenty-five subjects with a total of 50 subgingival restorations participated in this study. At the beginning of the investigation, nine teeth that were considered hopeless because of the extent of their pathology were selected for extraction to evaluate histologically the restorations and their effect on the adjacent tissues. The purpose of this article is to demonstrate the responses to the clinical applications as well as to the placement of resin-ionomers in subgingival lesions. Clinical and histologic evidence of epithelial and connective tissue adherence to resin-ionomer restorative materials was observed during the healing process.

Adult↗
PubMed2001

Oral health of ambulatory care patients.

OBJECTIVES: This project assessed the clinical oral health status of Veterans Administration (VA) patients and examined the relationship between oral health and both sociodemographic factors and dental care utilization. METHODS: Data were collected on 538 users of VA ambulatory medical care. Oral health was assessed by clinical examinations, and dental use and sociodemographic information are based on self-report. RESULTS: Younger, more educated VA patients with higher incomes had more teeth, fewer untreated and treated root caries, and were less likely to be edentulous or to have dentures. Dental utilization emerged as the most important aspect of veterans' oral health status, even after sociodemographic factors were controlled. Compared with the general population, veterans have poorer oral health with the exception of coronal caries. CONCLUSION: Compared with national studies, VA patients appear to have worse oral health. The importance of sociodemographic factors and dental utilization that has been found in other studies applies to veterans' oral health as well.

Adult↗
PubMed2001

Tobacco use and oral disease.

Tobacco use is a risk factor for oral cancer, oral mucosal lesions, periodontal disease and impaired healing after periodontal treatment, gingival recession, and coronal and root caries. Available evidence suggests that the risks of oral diseases increase with greater use of tobacco and that quitting smoking can result in decreased risk. The magnitude of the effect of tobacco on the occurrence of oral diseases is high, with users having many times the risk of non-users. There is a clear benefit to quitting tobacco use. The risks of oral cancer and periodontal disease decline as time from cessation increases, and some oral mucosal lesions may resolve with cessation of smokeless tobacco use. Smoking accounts for half of periodontal disease and three-fourths of oral cancers in the United States. Because tobacco accounts for such a high proportion of these diseases, comprehensive tobacco control policies are required to make progress in reducing the burden of tobacco-related oral diseases. Effective treatments to prevent tobacco use and increase cessation are available and need greater implementation. Dental practices may provide a uniquely effective setting for tobacco prevention and cessation.

Dental Caries↗
PubMed1999

[A study on the cariogenic bacteria of plaque on abutment teeth of casting and wrought wire clasp removable partial dentures].

OBJECTIVE: The effect of clasp on the health of abutment teeth. METHODS: To analyse and compare the cariogenic bacteria plaque getting from the buccal cervical third of casting and wrought wire clasp teeth before and one week after wearing removable partial dentures. RESULTS: The average percentages of Streptococcus Mutans and Actinomyces Viscosus in total culturable bacteria rised significently in statistical analysis, but there was no significent difference of Lactobacilli. The average percentage of Actinomyces Viscosus increased less after wearing casting clasp RPD than that of wrought wire clasp. CONCLUSION: Clasps of RPD increased the risk of root caries of abutment teeth. However the influence of casting clasps was smaller than that of wrought wire clasps.

Bacteria↗
PubMed2002

A 3-year clinical evaluation of a compomer, a composite and a compomer/composite (sandwich) in class II restorations.

PURPOSE: To compare the clinical performance of Dyract, Spectrum-TPH and Dyract layered with Spectrum-TPH (sandwich) in Class II restorations of permanent dentitions. MATERIALS AND METHODS: 23 adult patients aged 25-62 were selected at random in a general dental practice. Each patient had 3 bicuspid teeth restored with Dyract, Spectrum-TPH and a "sandwiched" combination where Dyract was covered by the composite resin TPH. During the entire study, three patients were lost. Restorations were clinically evaluated using a modified Ryge/USPHS system. RESULTS: Over 36 months all three types of restorations performed well clinically. No post-operative sensitivity was reported by any patient indicating proper bonding and sealing. Only one Dyract/TPH sandwich restoration had to be replaced after 2.5 years due to root caries. The Dyract restorations exhibited significantly higher (P = 0.0039) occlusal wear than the TPH and the Dyract/TPH sandwiched restorations. The marginal integrity was also found to be significantly better (P = 0.001) for the TPH and Dyract/TPH restorations compared to Dyract alone, while no significant difference (P > 0.05) could be demonstrated between TPH and Dyract/TPH restorations. The low rate of failure in the three different restorative systems suggests that they are reliable restorative materials in permanent bicuspids over a 3-year period.

Acetone↗
PubMed2003

[Effects of dentine phosphoprotein on remineralization of demineralized dentine].

OBJECTIVE: To investigate the relationship between dentine phosphoprotein (DPP) and remineralization of demineralized dentine. METHODS: (1) Soluble DPP was extracted with 1 mol/L NaCl from demineralized dentine and was evaluated. (2) Soluble DPP was removed with 0.1 mol/L NaCl or was not removed from demineralized dentine sections in human tooth roots. Then all sections were subjected to remineralization treatment, and remineralization degrees were compared by atomic absorption spectrum, SEM and microradiography. RESULTS: (1) Soluble DPP was extracted with 1 mol/L NaCl. (2) Removal of soluble DPP resulted in significantly lower calcium concentration in remineralization solution (P < 0.01), less mean light-absorbed value in demineralized dentin sections by microradiography (P < 0.01). CONCLUSIONS: Soluble DPP may have an inhibiting effect on remineralization of demineralized dentine, this study suggests that the remove of soluble DPP from root caries lesions may enhance their remineralization potential.

Adolescent↗
PubMed1992

Durability of cermet ionomer cement conditioned in different media.

The glass ionomer cement has exhibited significant adhesion to hard tooth structures, and good cariostatic properties. The sintering of the silver alloy powder and glass ionomer cement "cermet cement" has provided additional improvement in the physical properties of the restorative material. These were flexural resistance, wear resistance, increased radio-opacity, hardness and porosity. The improvement in the physical properties of the cermet glass cements has provided an extension in their clinical use as core build up, lining for inlays, amalgam and composite restoratives, fissure filling, restoration of primary teeth, class II tunnel preparation, treatment of root caries and repair of defective metal margins in crown and inlays.

Air↗