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PubMed2001

The reasons for extraction of permanent teeth in Scotland: a 15-year follow-up study.

AIMS: Although Scotland has the highest proportion of edentulous adults in the UK, the frequency of edentulousness has fallen by 21% during the last 20 years. This study, carried out in 1999, was designed to establish whether the reasons for tooth loss have also changed since 1984 when they were last determined. METHODS: The Scottish Dental Practice Board provided the names of every fourth dentist on its list among which 425 general dental practitioners were identified. They were asked to record permanent tooth extractions for 1 week, specifying the age, sex and dental attendance of patients who underwent extractions and the reasons for these extractions. 352 dentists took part: a response rate of 82.8%. RESULTS: The study confirmed that there has been a reduction in the number of extractions between 1984 and 1999: there were 25% fewer teeth extracted per patient and 30% fewer per dentist per week. From 0-20 years of age, orthodontics has replaced caries as the commonest reason for extraction and in all age groups over 20 years, caries has become the commonest reason in contrast to 1984 when periodontal disease was the principal reason in patients over 40 years old. CONCLUSIONS: Caries and its sequelae remain the most important cause of tooth loss throughout adult life in Scotland and, therefore, caries prevention and maintenance of restorations are of great importance at all ages.

Adolescent↗
PubMed1998

Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition.

Two hundred and eighty-seven children with a total of 545 traumatized primary upper incisors were followed using standardized procedures until the age of 10. Extraction was the only treatment offered when intervention was necessary. The immediate as well as the long-term consequences of trauma were studied on the basis of this material. Consequences in the primary dentition comprised: color changes (53%), pulp necrosis (25%), pulp canal obliteration (36%), gingival retraction (6%), permanent displacement after luxation (5-22%), pathological root resorption (1-10%) as well as disturbances in physiological root resorption (4%) and, lastly, premature tooth loss (46%). In a multivariate analysis of the development of pulp necross in primary teeth after trauma, the following decisive factors were found: age of the patient at the time of injury, degree of displacement of the tooth as well as the degree of loosening and presence of crown fracture. The factors found to influence development of pulp canal obliteration were: displacement of the tooth at time of injury as well as detectable physiologic root resorption at time of trauma. The presence of crown fracture seemed to decrease the risk of obliteration. The need for scientifically based treatment strategies for managing and reducting complications after trauma in the primary dentition is stressed.

Age Distribution↗
PubMed2025

Comparative Genomic Screening Identifies Developmental Constraint Loci Underscoring the Phenotypic Evolution of Syngnathids.

Seahorses and their relatives (syngnathids) exhibit remarkable diversity in morphology and function, characterized by their distinctive body shapes and specialized feeding mechanisms. Despite recent advances in uncovering the genetic basis of some traits, the genotype-phenotype map in syngnathids remains incomplete. In this study, we employed forward-genomic approaches and developed a method to enrich for human disease amino acid loci at a genomic scale. Our aim was to identify genetic loci associated with fin size reduction, tooth loss, and spinal curvature in syngnathids. Intriguingly, we identified a convergent amino acid change in the lat4a gene shared by syngnathids and some flying fishes, with in vitro analysis confirming its role in fin size evolution in both lineages. While genes critical for tooth development are conserved in syngnathids, the absence of key regulatory elements, such as pitx2, likely contributes to tooth loss. Additionally, we implicated col6a3 in spinal curvature development in seadragons. These findings reveal novel genetic signatures and developmental constraints underlying syngnathid diversity, demonstrating the utility of comparative genomics and targeted gene enrichment in exploring vertebrate evolution.

Animals↗
PubMed2002

Mandibular ramus flexure and gonial eversion as morphologic indicators of sex.

Recently, two mandibular traits--ramus flexure and gonial eversion--have come under close scrutiny (Loth & Henneberg 1996, 2000). The present study investigates the reliability of these two traits when each is applied as a single and independent indicator of sex, including the question of repeatability. The investigation was designed to give insights into possible confounding factors such as age and remodeling after tooth loss. Two samples, one of forensic (N = 153) and one of archaeological provenance (N = 80), were examined. The forensic sample was evaluated by a single observer while the archaeological sample was independently scored by three different observers. The results document that age and localized tooth loss seriously reduce the accuracy of these traits. For ramus flexure, male accuracy was only 66%, while female accuracy was even lower (32%). Overall accuracy was 59%. It is believed that the original scoring system devised by Loth and Henneberg (1996) creates an inherent bias in favor of males. For gonial eversion, a similar picture emerged (75.4% for males, 45.2% for females and 69.3% overall accuracy). Furthermore, both indicators are prone to intra- as well as inter-observer bias. While both possess some merit as sex indicators, they show marked functional and adaptive responses and may not be suitable for all samples.

Adult↗
PubMed1993

Tobacco use: a modifiable risk factor for dental disease among the elderly.

OBJECTIVES: Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. METHODS: Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. RESULTS: Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. CONCLUSIONS: Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.

Aged↗
PubMed1989

Dental aspects of hypophosphatasia: a case report, family study, and literature review.

The classic oral features of hypophosphatasia, namely, premature tooth loss and large pulp spaces, were found in a young adult woman with bone and joint pains. A study of 22 family members revealed several with dental abnormalities such as abnormal enamel, dentin, or cementum formation, decreased mandibular bone density, and abnormally large pulp spaces. Only the propositus' sister fulfilled the biochemical criteria for hypophosphatasia. Biochemical examination of an extracted tooth from this sister showed phosphate and alkaline phosphatase values that were 7 to 10 times lower than normal and reduced concentrations of the essential cofactors Zn++ and Co++. The spectrum of dental abnormalities is reviewed. This family study reveals that enamel hypoplasia, increased pulp spaces, and premature tooth loss are present not only in the deciduous but also in the permanent dentition. These findings should draw the dentist's attention to this condition.

Adult↗
PubMed1992

Epidemiology of dental diseases in the elderly.

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

Aged↗
PubMedDate not supplied

Clinical evaluation of short, machined-surface implants followed for 12 to 92 months.

PURPOSE: Bone resorption following tooth loss often limits the quantity of bone available for implant placement. The purpose of the present study was to evaluate the clinical outcome of 10-mm or shorter machined-surface implants when used exclusively in the treatment of various forms of edentulism. MATERIALS AND METHODS: Two hundred sixty-nine screw-type Brånemark System implants (Nobel Biocare), 10 mm or shorter, were placed in 111 consecutively treated patients. Of the total, 88.8% were placed in the mandible and 11.2% were placed in the maxilla; 95.2% were used to treat partially edentulous situations, including single-tooth losses, of which 96.6% were in the premolar and molar regions. The patients were followed for periods of 12 to 92 months. RESULTS: Of the 269 placed implants, 12 were lost. The overall survival rate was 95.5%. Bone quality 2 and 3 (Lekholm-Zarb classification of 1985) was found in 88.8% of the treated sites. There was no statistical difference in the survival rate of the 10-mm implants when compared to the shorter series (P > .05) or between the various implant diameters. The mean marginal bone loss was 0.71 +/- 0.65 mm. DISCUSSION: The failure rate of 4.5% compares favorably with that of implants of different shape, surface characteristics, and length. Bone quality appeared to be the critical factor in implant survival, rather than bone quantity, in this patient series. CONCLUSIONS: This study supports the survival of short, machined-surface implants when used for the treatment of partial edentulism in bone of good quality.

Adult↗
PubMed2006

Tooth wear and dental pathology at the advent of agriculture: new evidence from the Levant.

Differences in patterns of diet and subsistence through the analysis of dental pathology and tooth wear were studied in skeletal populations of Natufian hunter-gatherers (10,500-8300 BC) and Neolithic populations (8300-5500 BC, noncalibrated) from the southern Levant. 1,160 Natufians and 804 Neolithic teeth were examined for rate of attrition, caries, antemortem tooth loss, calculus, periapical lesions, and periodontal processes. While the Natufian people manifest a higher rate of dental attrition and periodontal disease (36.4% vs. 19%), Neolithic people show a higher rate of calculus. Both populations manifested low and similar rates of caries (6.4% in the Natufian vs. 6.7% in the Neolithic), periapical lesions (not over 1.5%), and antemortem tooth loss (3.7% vs. 4.5%, respectively). Molar wear pattern in the Neolithic is different than in the Natufian. The current study shows that the dental picture obtained from the two populations is multifactorial in nature, and not exclusively of dietary origin, i.e., the higher rate and unique pattern of attrition seen in the Natufian could result from a greater consumption of fibrous plants, the use of pestles and mortars (which introduce large quantities of stone-dust to the food), and/or the use of teeth as a "third hand." The two major conclusions of this study are: 1) The transition from hunting and gathering to a food-producing economy in the Levant did not promote changes in dental health, as previously believed. This generally indicates that the Natufians and Neolithic people of the Levant may have differed in their ecosystem management (i.e., gathering vs. growing grains), but not in the type of food consumed. 2) Changes in food-preparation techniques and nondietary usage of the teeth explain much of the variation in tooth condition in populations before and after the agricultural revolution.

Agriculture↗
PubMed1983

The potential for increase in the periodontal diseases of the aged population.

The periodontal disease trends in the nation's older adults aged 55 to 74 years are assessed using National Center for Health Statistics data spanning an approximate 12-year period. Both the 1960 to 1962 Health Examination Survey and the 1971 to 1974 Health and Nutrition Examination Survey I surveys used similar multistaged stratified probability samples. Examinations were calibrated and the collection of periodontal disease (PI), oral hygiene (OHI) and tooth loss scores were standardized. Data were collected on 1567 persons in 1960 to 1962 and 4746 persons in 1971 to 1974. The mean PI scores between the two surveys were not statistically different. However, when the periodontal diseases were divided into individuals with or without pockets, there was a significant decline in the per cent without pockets (P less than 0.001) while the per cent with pockets remained unchanged or increased. The significant reduction in OHI scores (P less than 0.02) seems to validate the decrease in gingivitis. The improvement in tooth loss was reflected by both the greater proportion of dentulous adults, and among the dentulous, a retention of more than two teeth per person by 1971 to 1974. A hypothesis is discussed regarding tooth retention and the periodontal diseases with projections for the year 2000.

Age Factors↗
PubMed1990

Dental pathology and alcohol-related indicators in an outpatient clinic sample.

A relationship between alcoholism and dental pathology (particularly missing teeth), has been reported in studies of male, inpatient alcoholics. The present exploratory study was undertaken to assess how readily these findings can be generalized to an unselected sample of male and female dental patients. Data on drinking behavior, alcohol-related problems, and risk factors for alcoholism were obtained through an interview and questionnaire. A dental chart review provided measures of dental pathology. The results showed that measures of dental pathology (including tooth loss, carious teeth, and periodontal disease) correlated significantly with alcohol-related indicators. The associations were more evident for males than for females, which is consistent with some studies of alcohol-related medical consequences. The results suggest that further analytic studies of alcohol consumption and dental pathology are warranted. Because the relationship between tooth loss and harmful drinking was clearest among males with a history of conduct problems, subsequent research would benefit from a focus on this high-risk group.

Adult↗
PubMed1997

Analytic approaches to longitudinal caries data in adults.

The objective of this paper is to consider current methods for analyzing longitudinal caries data in adults. To illustrate these methods, we used data from the Piedmont dental study, a prospective investigation of the oral health of older adults. Longitudinal dental data sets comprise repeated observations of an outcome (often clustered within randomly selected primary sampling units), and a set of covariates for each of many subjects, in whom clustering can occur as a result of measuring teeth, or surfaces, within people. One objective of statistical analysis is to predict the outcome variable as a function of the covariates, while accounting for the correlation among the repeated observations for a given subject and the effect of clustering within subjects, as well as between subjects within primary sampling units, such as communities, schools, hospitals, or other such units. We considered two statistical approaches: generalized estimating equations and survey regression models. We also examined the impact of varying diagnostic criteria for caries estimation between epidemiologists and clinicians. One approach is to perform the usual time(x) exam score minus time0 score analysis for the baseline and final examinations, while an alternative is to analyze trends among interim examinations. Finally, because caries studies in which the onset of the disease is the endpoint face the problem of censoring due to subject attrition and/or tooth loss, we recommend the incidence density (time-to-event) analytic strategy to address this problem. This approach was found to be most suitable for longitudinal studies of older adults since it accounts for the time each surface remains at risk for the event of interest, making use of interim exam data until the moment the subject and/or the tooth are no longer available for examination. We also included a discussion on biases that occur upon application of the usual methods of estimating caries experience in missing teeth and crowns, which often ignore the classification error in the estimation. We propose a method to adjust for misclassification of the M-component of the DMFS index. In the case where one can observe true reversals or remineralization of caries lesions, we recommend an adjustment formula to account for reversals that are most likely due to examiner misclassification. We provide examples to demonstrate the applicability of the methods for covariates subject to outcome misclassification.

Adult↗
PubMed2004

The comparison of the thickness of the cementum layer in Type 2 diabetic and non-diabetic patients.

It has been suggested diabetes plays an important role in tooth loss. Studies examining the periodontal structures and the alveolar bone architecture in diabetics have revealed some alterations. However, mechanisms responsible for these alterations have not been elucidated completely. Established relationships between the cementum layer, which is resistant to resorption, and diabetes are few in number. The aim of this study was to compare the thickness of the cementum layer in Type 2 diabetic and non-diabetic subjects in order to improve the understanding of dental mobility in Type 2 diabetes and its effect on tooth loss. A total of 46 male patients with a mean age of 61.72 +/- 5.45 yr. were included in this study (Type 2 diabetics, n=23; non-diabetics, n=23); undecayed. Single rooted premolar teeth extracted from 46 male patients were used to assess the alterations in the cementum layer in Type 2 diabetics. Histological preparations from extracted teeth were examined under light microscopy. In each tooth, the thickness of the cementum layer was measured by an oculometer in 4 different sites on the specimen with the largest pulp space including the pulp chamber and root canals. Statistical analyses were performed with student's t test. The average thickness of the cementum layer in the decalcified teeth extracted from non-diabetic patients was compared to the average thickness of the cementum layer in Type 2 diabetic patients. A significant difference was observed in every site of measurement between Type 2 diabetic and non-diabetic patients with regard to the thickness of the cementum layer (p < 0.05). The cementum layer was thicker at the apical part of the root and at the midpoint of the apical half, and thinner at the central part of the root and at the midpoint of the coronal half in Type 2 diabetic patients.

Aged↗
PubMed1994

Caries prevalence in the Republic of Ireland.

The implementation of the Health (Fluoridation of Water Supplies) Act 1960 was preceded by a survey of child dental health in the Republic of Ireland. A follow up national survey in 1982 showed that caries had declined in both fluoridated and non-fluoridated communities, although more so in the former. An adult dental health survey reported in 1992 showed that tooth loss had declined in the period 1979 to 1989.

Adolescent↗
PubMed2006

Behavioral factors to include in guidelines for lifelong oral healthiness: an observational study in Japanese adults.

BACKGROUND: The aim of this study was to determine which behavioral factors to include in guidelines for the Japanese public to achieve an acceptable level of oral healthiness. The objective was to determine the relationship between oral health related behaviors and symptoms related to oral disease and tooth loss in a Japanese adult community. METHODS: Oral health status and lifestyle were investigated in 777 people aged 20 years and older (390 men and 387 women). Subjects were asked to complete a postal questionnaire concerning past diet and lifestyle. The completed questionnaires were collected when they had health examinations. The 15 questions included their preference for sweets, how many between-meal snacks they usually had per day, smoking and drinking habits, presence of oral symptoms, and attitudes towards dental visits. Participants were asked about their behaviors at different stages of their life. The oral health examinations included examination of the oral cavity and teeth performed by dentists using WHO criteria. Odds ratios were calculated for all subjects, all 10 year age groups, and for subjects 30 years or older, 40 years or older, 50 years or older, and 60 years or older. RESULTS: Frequency of tooth brushing (OR = 3.98), having your own toothbrush (OR = 2.11), smoking (OR = 2.71) and bleeding gums (OR = 2.03) were significantly associated with number of retained teeth in males. Frequency of between-meal snacks was strongly associated with number of retained teeth in females (OR = 4.67). Having some hobbies (OR = 2.97), having a family dentist (OR = 2.34) and consulting a dentist as soon as symptoms occurred (OR = 1.74) were significantly associated with number of retained teeth in females. Factors that were significantly associated with tooth loss in both males and females included alcohol consumption (OR = 11.96, males, OR = 3.83, females), swollen gums (OR = 1.93, males, OR = 3.04, females) and toothache (OR = 3.39, males, OR = 3.52, females). CONCLUSION: Behavioral factors that were associated with tooth retention were frequency of eating snacks between meals, tooth brushing frequency, having one's own toothbrush, smoking and drinking habits, having hobbies, having a family dentist and when they had dental treatment. Clinical factors included bleeding gums, swollen gums, and toothache.

Journal Article↗
PubMed1985

Dental attendance and dental status.

This article examines the relationship between differences in dental attendance patterns and variations in dental status. A sample of 336 dentate men and 110 dentate women were selected at random from employees of two industrial plants in N.W. England in 1980. They were given a dental examination and asked about visits to the dentist. Regression analysis showed that while the more frequent the dental visits, the lower the rate of tooth loss and the fewer the number of teeth with active decay, the higher, however, the average number of fillings. There were significant differences, moreover, between manual and non-manual workers, the former being more likely to lose their teeth and the latter to have their teeth filled, at each given age and frequency of dental visit. Though the more frequent dental attenders had the advantage over the less frequent of having, on average, a higher number of functioning teeth, restored or otherwise sound, they also had the disadvantage of having higher levels of treated disease and thus of disease experience. The results suggest that while frequent dental visits help to postpone tooth loss and to maintain dental function, they do not apparently help to prevent the onset of further disease.

Adolescent↗
PubMed2006

Spanish version of the Oral Health Impact Profile (OHIP-Sp).

BACKGROUND: The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency. METHODS: The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12-21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions. RESULTS: The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL > or = 3 mm' with a mean OHIP-Sp score = 13.0. CONCLUSION: The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's alpha). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.

Journal Article↗