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PubMed2003

Endodontic variables and coronary heart disease.

This cross-sectional study was designed to explore a possible association between endodontic disease variables and coronary heart disease (CHD). Dental infections are hypothesized to be linked to atherosclerosis and could be a cause of vascular changes crucial for the development of CHD. Most studies have focused on periodontal disease. To our knowledge, no one has specifically studied endodontic variables as risk factors for the development of CHD. In 1992-93, a representative sample (n = 1056) of women in Göteborg, Sweden, aged between 38 and 84 years, took part in a combined dental and medical survey. The dependent variable was CHD, i.e. subjects with angina pectoris and/or a history of myocardial infarction (n = 106). The independent variables were number of root-filled teeth (RF), number of teeth with periapical radiolucencies (PA), tooth loss (TL), age, life situation, marital status, smoking, alcohol habits, body mass index, waist-hip ratio, serum cholesterol and triglyceride concentrations, hypertension and diabetes. The multivariate logistic regression analysis did not prove the endodontic variables to be predictive of CHD. Only age and tooth loss were significantly associated with CHD, with OR = 1.07 (CI = 1.03-1.12) and OR = 2.70 (CI = 1.49-4.87), respectively. The bivariate logistic regression analysis showed a positive significant association between subjects with RF = 2 and CHD, but for PA the bivariate analysis did not support an association with CHD. This cross-sectional study did not reveal a significant association between endodontically treated teeth and CHD nor between teeth with periapical disease and CHD.

Adult↗
PubMed2005

Morphometric evaluation of the human tractus solitarius.

We measured the cross-sectional area (CSA) of the human tractus solitarius (HTS) with the help of an image-analyzer system on a cross section of the upper part of the medulla oblongata in 44 Japanese cadavers (22 males and 22 females) and examined the relationship between age, sex and whether the subjects were dentulous or edentulous. The results showed no significant differences between the left and right sides of the HTS in either male or female subjects. However, the size of HTS decreased slightly with age in males but not at all in females, whereas tooth loss had a definite incidence on the size of HTS in females but not in male, as the CSA was smaller in edentulous females but not in edentulous males. This would tend to indicate that a decreases in taste function is connected with the aging process in male, and with tooth loss in females.

Age Factors↗
PubMed1990

Space maintenance in the primary and early mixed dentition.

Many malocclusions are caused by a loss of arch length subsequent to premature tooth loss. Dental practitioners with a knowledge of several simple but effective types of arch length maintainers, can prevent some developing malocclusions.

Child↗
PubMed1999

Incidence of, and reasons for, tooth mortality among mentally retarded adults during a 10-year period.

The aim of the study was to investigate the reasons for, and incidence of, tooth mortality over a 10-year period in mentally retarded adults receiving regular dental care. The number of teeth present in 115 individuals (mean age in 1984 was 41.0, range 19-83 years) was registered in 1984 and 1994. The reasons for tooth mortality, medication utilization, frequency of dental care visits and cooperation during dental treatment were registered and related to tooth loss. The average incidence of tooth mortality was 3.72 teeth during the 10-year period. The mean number of dental care visits per year was 6.6. Most of the 428 teeth (58%) were lost due to periodontal disease. The preventive dental care given was not sufficient to arrest oral diseases. The data indicate, however, that achievement of cooperation in dental care situations not only makes dental treatment possible, but also leads to a decreased incidence of tooth mortality.

Adult↗
PubMed1992

Profiles of periodontal conditions in older age cohorts, measured by CPITN.

Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.

Africa↗
PubMed1976

Dental complications of cytotoxic therapy in Hodgkin's disease--a case report.

A case of trigeminal zoster in a patient with disseminated Hodgkin's disease is described. Although one case of maxillary tooth loss in a comparable patient has previously been recorded, this is the first report of mandibular tooth loss. The aetiological significance of Beomycin and I-(2-chloroethyl)-3-cyclohexyl-I-nitrosourea (C.C.N.U.) is discussed and an hypothesis for post-zoster tooth exfoliation is suggested.

Adult↗
PubMed2002

Orthodontic treatment outcomes in the long term: findings from a longitudinal study of New Zealanders.

The aim of this study was to use a health services research (HSR) approach to examine the longer-term outcomes of orthodontic treatment. Participants in a longstanding population-based New Zealand cohort study (the Dunedin Multidisciplinary Health and Development Study) were allocated to one of four malocclusion severity categories on the basis of orthodontic data collected at age 12. The outcome of that care by age 26 was evaluated using the key indicators of equity (was it fair?); efficacy (did it work?); effectiveness (did it work in the longer term?); and safety (was it associated with a greater subsequent experience of caries, periodontal disease, or tooth loss?). Data were available for 452 Study members, of whom 56.2% were in the minor/none category, 29.0% were in the definite category, 10.2% were in the severe category, and 4.6% were in the handicapping treatment-need category. No clear differences in treatment uptake by socioeconomic status were apparent, and the proportion treated increased across the malocclusion severity categories, as did the proportion that showed an improvement following treatment. By age 26 a difference between those who had and those who had not been treated was evident, with the percentage of those rating their dental appearance as above average increasing with increasing severity of the age-12 orthodontic treatment need. This was also true for the percentage that considered their orthodontic treatment to have been successful. There were no significant differences in caries experience, periodontal disease occurrence, or tooth loss between those who had and had not been treated by age 26. This study has found the equity, efficacy, effectiveness, and safety of orthodontic treatment in the Dunedin cohort to be acceptable.

Adolescent↗
PubMed1999

Extraction of teeth over 5 years in regularly attending adults.

OBJECTIVES: This prospective study was conducted to describe the incidence of tooth extraction in a group of regularly attending adults and to assess factors that are predictive of tooth loss. METHODS: Baseline and annual incremental clinical data were obtained from 23 general dental practitioners on a group of their regularly attending, dentate adult patients over a 5-year period. The patients completed a postal questionnaire with questions relating to dental health behaviours, attitudes and knowledge, and social factors. RESULTS: Complete clinical data were obtained from 2799 patients. Four hundred and seventy (17%) patients underwent extractions, 72% of which were posterior teeth. The majority of extractions were for reasons other than caries (79%). Bivariate analyses revealed many significant differences between patients who underwent extractions and those who did not, with respect to the clinical, social, behavioural and attitudinal variables. The logistic regression model for tooth loss included three clinical variables, number of teeth, crowns and sites with recession. Other variables in the final model included the dentist's and patient's prediction of treatment need, having sensitive teeth, having a sweet tooth, living alone and smoking. The sensitivity for the model was 0.57 with specificity 0.72. CONCLUSIONS: This study is unique in its examination of patients and has highlighted that both clinical and other factors are important in predicting who will undergo extractions. Future investigations should assess the consequence of having extractions in terms of health benefit or detriment.

Adult↗
PubMed2004

Reappraising prosthodontic treatment goals for older, partially dentate people: Part I. Traditional management strategy.

In conventional terms, prosthodontic treatment becomes necessary when a patient has missing and/or broken-down teeth. Part I of this two-part series of papers reviews the available evidence for a traditional therapeutic model that seeks purposefully to reconstitute lost morphology, with specific reference to older, partially dentate people, at the population level. Furthermore, because anterior and premolar teeth are indispensable to a number of prime oral functions in most societies, the question of need for replacement relates essentially to that of molar teeth. Research findings are presented which cast doubt on many of the assertions made for the mandatory replacement of all posterior teeth. Specifically, there appears to be a lack of compelling evidence that dental arch integrity is a prerequisite for optimal oral health and function, and favours the prognosis of the remaining dentition. Wide variability in the effects of posterior tooth loss on occlusal stability indicates a 'wait-and-see' management approach rather than immediate replacement, while reported chewing sufficiency in people with reduced but well-distributed dentitions, and a lack of association between the level of posterior support and temporomandibular disorders, further undermine the traditional premise for the mandatory replacement of posterior teeth, specifically molars. With the parallel recognition that the assessment of treatment need must take a broader view of peoples' functional concerns arising from their tooth loss, as well as weighing the cost/benefit ratio of treatment, Part II will compare the merits of the traditional model with the documented functional benefits that a more limited, less morphologically-driven approach may have for the growing, older sector of society.

Aged↗
PubMed2001

Prevalence of periodontal conditions among public-funded dental patients in Australia.

BACKGROUND: The aims of this study were to describe periodontal health status by gender, type of care, geographic location and age and to investigate associations of these factors with tooth loss. METHODS: In 1995-96, state and territory dental services surveyed a random sample of 6,109 public-funded patients. Dentists recorded oral health status at the initial visit of a course of care, using written instructions but without formal calibration. Periodontal status was assessed using the community periodontal index of treatment needs. RESULTS: Prevalence of periodontal conditions among dentate patients was higher among older, male, emergency and urban patients (chi2; p<0.05). Age-specific edentulism was lower for male, emergency and urban patients (chi2; p<0.05). Numbers of missing teeth were lower for younger, non-emergency and urban patients (Anova; p<0.05). Prevalence of periodontal pockets 6mm or more was associated with gender, type of care, geographic location, age and number of missing teeth (logistic regression; p<0.05). CONCLUSIONS: Prevalence of severe periodontal conditions was lower in 1995-96 compared with public-funded patients in 1984 and 1992-93, but prevalence of periodontal health remained lower than the general population in 1987-88. A survivor effect may result in lower recording of severe periodontal conditions among subgroups with higher tooth loss.

Adolescent↗
PubMed2001

Perceptions of oral health: the South African Demographic and Health Survey of 1998.

Oral diseases are widespread in South Africa and affect large numbers of people in terms of pain, tooth loss, disfigurement, loss of function and even death. The majority of South Africans have no access to private services and are dependent on the government for oral health care services, but less than 10% of the population utilises public oral health services. This underutilisation is due to limited resources and inaccessibility. This article reports on the data collected on adults, 15 years and older, from the South African Demographic and Health Survey carried out in 1998, relating to perceptions of oral health. The questions dealt with oral health problems, utilisation of oral health services, loss of natural teeth, oral health practices and knowledge of water fluoridation. The results are discussed in terms of age, gender, education, place of residence, province and classification according to the previous population registration act. A high proportion (36%) of people had experienced oral health problems. Teeth problems were most commonly reported in the higher age groups, non-urban areas, Eastern Cape, Northern Cape and Free State, people with little education and those classified as non-urban Africans. Significant differences were found in regard to periodontal disease, tooth loss, knowledge of fluoride between groups according to age, geographic location, race and level of education. 62% of the respondents reported that they had lost some of their natural teeth and in some communities almost a third of the respondents were edentulous. In comparing the goals of the current draft national oral health policy with the findings of this survey the following implications for policy development should be noted: A higher priority needs to be given to oral health issues; Improve access by increasing primary health care facilities through the delivery of oral health care services; The high prevalence of hepatitis and HIV/AIDS infection poses a higher risk to oral health personnel and the public and The successful implementation of water fluoridation depends upon public knowledge, understanding and support.

Adolescent↗
PubMed2006

Interviews and assessments of returning non-compliant periodontal maintenance patients.

BACKGROUND: Periodontal therapy without a maintenance programme has been shown to be of doubtful value. Most studies show a low-level of compliance with periodontal maintenance therapy. Many suggestions as to the reasons for this have been put forward, but it has been difficult to confirm these, as the patients are not available to be interviewed. AIM: To identify, interview and assess returning non-compliant periodontal maintenance patients. METHOD: All patients who had undergone periodontal therapy between 1986 and 2004 but not complied with the maintenance therapy were interviewed and assessed when they later returned to the specialist office for treatment. RESULTS: Sixty-one patients with an average age of 56.4 years (SD 11,1) were studied. There were 18 males and 43 females. The patients were compliant for 3.4 years (SD 3.2) before leaving and returning after 5.5 years (SD 3.3) of non-compliance. Average tooth loss while non-compliant was 1.6 teeth (SD 2.8). The interviews revealed that 37 patients attended their own dentist's office exclusively for maintenance therapy, eight patients gave health reasons and seven patients lack of motivation or failure to cooperate. Thirty-six patients were re-referred by their own dentist, 13 changed dentist and were referred by this dentist, while 12 patients contacted the specialist office directly. Fifty-three patients claimed to have been fully compliant with their own dentist while non-compliant with the specialist office. CONCLUSION: The main reason for non-compliance was that the patients did attend their own dentist exclusively for maintenance therapy. Tooth loss and periodontal deterioration was more marked in this group than patients who in addition attended the specialist office for maintenance therapy.

Adult↗
PubMed2004

Eruptive tooth movement--the current state of knowledge.

How the dentition erupts, and what controls it, is fundamental to almost all aspects of clinical dentistry, yet the mechanisms behind this have not yet been fully elucidated. When the process continues into space that has been created through toothwear or tooth loss, problems in placing restorations can be encountered. This review examines the possible mechanisms of tooth eruption. Differences between processes in animals and humans are highlighted. The limitations of conclusions drawn from animal studies are then discussed with reference to human dental conditions. The differing forms of overeruption in humans are described and the treatment options for overerupted teeth, including prevention of the situation arising, are provided with a discussion of the quality of the evidence base behind these.

Animals↗
PubMed2002

The role of occlusal stress and gingival infection in the formation of exostoses on mandible and maxilla from Neolithic China.

Exostoses on the mandible and maxilla is a frequently observed bone growth of controversial aetiology. The aim of this study is to analyse environmental factors that may stimulate the formation of exostoses on different regions of the maxilla and mandible. Sixty-six well-preserved crania from Neolithic China were studied for the presence of buccal exostoses on the maxilla (BE) and lingual exostoses on the mandible (LME). Other oral health indicators, such as occlusal wear on molars, pathology of temporomandibular joint (TMJ), carious lesions, calculus accretion, periodontal disease, and antemortem tooth loss were recorded. Buccal maxillary exostosis was unusually common on the Neolithic skulls from China, which thus resemble the Sinantropus crania described by Weidenreich (1943). We report a significant Spearman correlation between BE and LME (rho = 0.54, P < 0.00001), suggesting a partially shared aetiology of these two types of exostoses. The highest correlations between either form of exostoses and any oral indicator of stress were found for pathology at TMJ (rho = 0.46, P < 0.0001 for both types of exostoses). Smaller but significant correlations were observed between LME and the age adjusted wear rate on lower molars, as well as between BE and indicators of oral/dental pathology, e.g. caries, calculus, periodontoses, and antemortem tooth loss. Both types of exostoses tended to increase in frequency with age, although a significant trend was observed only for BE. We conclude that formation of exostoses is a complex process that can be invoked by any agent causing damage and inflammation of gingival tissue. However, severe occlusal stress, which is often manifested in TMJ disorder, is the main environmental factor leading to exostosis development in genetically pre-disposed individuals.

Adult↗
PubMed1999

Tooth surface loss. 11. Surgical crown lengthening.

Restoration of worn teeth can be made easier by surgical crown lengthening. It improves appearance and facilitates tooth preparation. Anatomical features can limit the height that can be gained.

Crown Lengthening↗
PubMed1993

Health services and women's oral health.

Apart from tooth loss and edentulism, data on the relative levels of oral health of men and women are scarce. Evidence from Europe and to a lesser extent from the U.S. shows that women have fewer natural teeth present than men and have higher levels of edentulism. In Europe there is some evidence that socially deprived rural women have the highest levels of edentulism. Due to the lack of adequate detail in published reports of studies, it is difficult to relate the oral health of women with the availability, acceptability, and accessibility of dental services. Women tend to attend for dental care more regularly than men though there is some evidence that women are more fearful of dental treatment and also perceive cost as a barrier to dental care. Data from the Republic of Ireland suggest that women working in the home have higher levels of tooth loss and edentulism than those working outside the home. There is a need for consensus on methods of reporting oral health data in major descriptive studies. Further research is required to investigate why women tend to lose their natural teeth at an earlier age than men.

Adolescent↗