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PubMed1991

Qualitative study of oral health norms and behaviour among elderly people in Scotland.

This study was undertaken to examine oral health norms and behaviour among elderly people in Scotland. Qualitative methodology in the form of informal group discussions was used. The study population comprised 9 groups of 6-8 respondents aged 65 years and over, selected according to the quota criteria of sex, social class, level of dependency and oral health status. All groups were recruited by a professional market research interviewer, using a random route procedure. Discussions were conducted under the guidance of an experienced group moderator and tape recorded. Each group discussion lasted between 1 1/2 and 2 1/2 hours. The results showed that oral and denture hygiene was a sensitive issue and part of individual routine behaviour which most respondents were reluctant to change. Tooth loss was expected and accepted as part of a natural ageing process. Dental visits were regarded as problem-solving behaviour; self-care was preferred to professional care; non-attendance was explained by no perceived need, low interest, fear or expected high cost. Health was seen in an illness context or in a positive lifestyle context and not associated with oral health. The main conclusions were: oral health behaviour was characterised either as personal routine behaviour or as problem-solving behaviour. Tooth loss was expected. Oral health was perceived as unrelated to general health. The elderly saw no incentive or reason to change these norms and behaviours.

Aged↗
PubMed2005

Survival rate of endodontically treated teeth in relation to conservative vs post insertion techniques -- a retrospective study.

AIMS AND METHODS: The purpose of this retrospective, non-randomised cohort study was to evaluate the success rate of 775 endodontically treated teeth depending on the restoration type. A total of 508 patients with 775 endodontically treated teeth were examined during at least 12 months. The radiographic controls, time span between root canal filling and definitive restoration, restoration material type, inserted post system type and the occurrence of possible endodontically as well as restorative post-operative complications were recorded. RESULTS: 18.3% of the 775 investigated teeth were incisors and canines, 33.5% were premolars and 48.2% molars. Pre-fabricated and casted metal post systems were used only in 15.6% of the endodontically treated teeth (18.4% incisors and canines, 44.8% premolars, 36.8% molars). 6.6% of the teeth had endodontically related symptoms or severe complications, whereas in 13.2% of the teeth restored with metal posts showed complications, such as root or crown fractures. The Cox-Regression analysis showed that teeth restored with a post system had a statistically significant higher failure rate (p = 0.044) than those which had been restored without posts. CONCLUSIONS: The results showed a high success rate for endodontically treated teeth when the final restoration was placed within a short period of time (two weeks). A higher tooth loss was observed when metal post systems were employed suggesting that precaution is recommended when these types of posts are inserted.

Acrylic Resins↗
PubMed2003

Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects.

BACKGROUND: Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. There is evidence to show that amelogenins are involved not only in enamel formation, but also in the formation of the periodontal attachment during tooth formation. OBJECTIVES: To test the efficacy of EMD in comparison with open flap debridement, GTR and various BG procedures for the treatment of intrabony defects. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomised controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: January 2003. SELECTION CRITERIA: RCTs on patients affected by periodontitis having intrabony defects treated with EMD compared with open flap debridement, GTR and various BG procedures with at least one year follow up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), marginal bone levels on intraoral radiographs and postoperative infections. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval (CI). Heterogeneity was investigated including both clinical and methodological factors. MAIN RESULTS: No difference in tooth loss was observed. A meta-analysis including eight trials showed that Emdogain treated sites displayed statistically significant PAL improvements (mean difference 1.3 mm, 95%CI: 0.8 to 1.8) and PPD reduction (1 mm, 95%CI: 0.5 to 1.4) when compared to flap surgery. Comparing Emdogain with 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. REVIEWER'S CONCLUSIONS: Emdogain is able to significantly improve PAL levels (1.3mm) and PPD reduction (1mm) when compared to flap surgery, however these results may not have a great clinical impact, since it has not been shown that more periodontally compromised teeth could be saved. There was no evidence of clinically important differences between GTR and Emdogain.

Alveolar Bone Loss↗
PubMed1999

[The comparison of bone densities of mandible and coxofemoral region between senile people with edentulous jaws and those with dentate jaws].

OBJECTIVE: To observe if the senile people with edentulous jaws had lower bone dentilies of mandible and coxofemoral region than those with dentate jaws, and to find the systemic risk factors which were responsible for the tooth loss and the formation of edentulous jaws. METHODS: Two groups of senile people were selected. One group was edentulous and the other was dentate. All of them were examined by dual energy X-ray absorptiometry(DXA). RESULTS: The senile people with edentulous jaws had significantly lower bone densities of mandible(P < 0.001) and they also had lower bone densities of coxofemoral region than the dentate group people. CONCLUSION: It indicated that the decreased of bone densities of mandible and coxofemoral region was one of the systemic risk factors for tooth loss and the formation of edentulous jaws.

Age Factors↗
PubMed2003

Oral diseases and conditions in community-living older adults with and without dementia.

This study compared the prevalence and experiences of oral diseases and conditions, as well as tooth loss and retained root status, in community-dwelling older adults with and without dementia. Dental examinations were conducted at baseline and at one-year for randomly selected samples of 116 dentate community-living older adults with dementia and a comparable group of 116 adults without dementia. Participants with dementia had significantly higher experiences of oral diseases and conditions at baseline and one-year compared with participants without dementia: decreased use of dentures; increased prevalence of denture-related oral mucosal lesions; increased plaque accumulation; increased prevalence and experiences of coronal and root caries; and increased numbers of decayed retained tooth roots. These higher experiences of oral diseases and conditions were related to dementia severity, not to specific dementia diagnoses. Participants with dementia already had a compromised oral health status when admitted into institutional long-term care between baseline and one-year; of concern were the high plaque levels on the natural teeth of the group of institutionalized participants with dementia.

Aged↗
PubMed1997

Remaining mandibular third molars in an adult population.

Although tooth loss with age has been extensively investigated, there appears to be no literature on the relationship of age to remaining mandibular third molars. The study showed that as age increases so does the frequency of absent vertically erupted mandibular third molars. However, no correlation was found between age and loss of mandibular impacted third molars in men of 71 years of age or older. The evidence presented here suggests that impacted mandibular third molars, which have not been infected, may be more likely to remain compared with other teeth at potential risk.

Adult↗
PubMed1998

Bone mineral density in periodontally healthy and edentulous postmenopausal women.

(Osteoporosis is the most common metabolic disease among postmenopausal women. Reduced masticatory function caused by tooth loss may be a contributing risk factor of osteoporosis. The present study examined the effect of dentate state on skeletal bone mineral density (BMD) in postmenopausal women. Fourteen periodontally healthy dentate subjects (group H; mean age: 64.0 + 5.5 years) and 12 edentulous subjects (group E; mean age: 67.1 + 2.9 years) were randomly selected from the clinics of the departments of Periodontology and Gerodontology, respectively. Informed consent was obtained from all participants. BMD of the lumbar spine (L2-L4) was measured by dual energy x-ray absorptiometry. In addition, occlusal force was measured in 11 group H subjects and 8 group E subjects by using an occlusal diagnostic system. Risk factors associated with osteoporosis including age, calcium intake, physical activity, and cigarette smoking and causes of tooth loss were assessed by interview and questionnaire sent to all participants. The BMD of group H was 1.07 t 0.21 g/cm2 and that of group E was 0.89 + 0.17 g/cm2, which was significantly different(P< 0.05). The occlusal force of group H and E patients was 312.4 + 148 Nand 56.3 + 36 N, respectively, which was significantly different (P< 0.05). Risk factors such as calcium intake, physical activity, and smoking did not differ significantly between the 2 groups. Thus, the periodontally healthy dentate women, who showed about 6 times higher occlusal force than edentulous women, maintained significantly higher BMD of the lumbar spine than edentulous women. Our results suggest that sufficient masticatory function with periodontally healthy dentition may inhibit or delay the progress of osteoporotic change in skeletal bone or that edentulous women may be more susceptible to osteoporosis.

Absorptiometry, Photon↗
PubMed1993

Survival characteristics of periodontally-involved teeth: a 40-year study.

Four hundred and fifty-five teeth that were judged clinically to have a questionable prognosis were observed over a 40-year span in 166 patients in a private practice. Therapy initially was debridement with oral hygiene instruction, followed by flap curettage procedures and preventive maintenance recall therapy. An assessment of compliance based on oral hygiene and recall attendance was also performed. A total of 55 (12%) teeth were lost with an average survival rate of 8.8 years prior to extraction. No teeth were lost during the first 2 years of observation. The majority of extracted teeth were maxillary second molars (38.2%), followed by maxillary first molars (25.5%), and mandibular second molars (16.4%). Tooth loss patterns appeared to be bilaterally symmetrical, with 51% of teeth lost in the right quadrants and 49% lost in the left quadrants. Indications for extraction were primarily periodontal abscesses. Teeth that were considered to have a very questionable prognosis have been retained for many years after therapy, supportive treatment, and patient compliance with recall attendance.

Adult↗
PubMed2001

The periodontal-systemic connection: implications for treatment of patients with osteoporosis and periodontal disease.

Osteoporosis and osteopenia may influence periodontal disease and tooth loss. Medications such as hormone replacement therapy and nutritional supplements that are used to prevent or treat osteoporosis have been evaluated for beneficial effects on oral health in a small number of human studies. Hormone replacement therapy (HRT), which slows the rate of bone loss at skeletal sites such as the hip and spine, also appears to reduce the rate of alveolar bone loss in postmenopausal women. HRT use is consistently associated with greater tooth retention and a reduced likelihood of edentulism in studies of elderly women. The number of studies on the effects of calcium or vitamin D intake on oral outcomes is limited, but suggest that higher intake levels are associated with reduced prevalence of clinical attachment loss and lower risk of tooth loss. Data from a prospective study of oral health in men show a similar association between higher calcium intake and reduced alveolar bone loss. The number of teeth with progression of alveolar bone loss over a 7-year period was significantly lower among men whose calcium intake was at least 1,000 mg per day, compared to men with a calcium intake below this level. Future studies should confirm these findings and evaluate the oral effects of new medications for osteoporosis. If confirmed, the implications for dental professionals may include an expanded array of medications for the treatment of periodontal disease and a greater emphasis on nutrition education for patients.

Aged↗
PubMed1983

Circumstances favoring jaw tumors in Burkitt's lymphoma.

In Burkitt's lymphoma, dental structures may provide the route for Epstein-Barr virus (EBV) in saliva to penetrate the jaws, thereby promoting tumor formation. In children, EBV could enter tooth sockets exposed following deciduous tooth loss and thereby contact jaw marrow lymphocytes stimulating neoplastic transformation. Marrow contact by EBV probably also occurs through carious teeth. Jaw tumors are rare in adults because their jaw marrow is no longer hematopoietic and so lacks the lymphoid substrate for the virus. In adults, jaw marrow lymphocytosis, as accompanies infectious mononucleosis and perhaps malaria, or which could develop around the roots of carious teeth having chronic periapical infection, could provide the substrate for EBV. EBV could then contact the jaw marrow lymphocytes when teeth are extracted and so favor jaw tumor development. Therefore, prevention of dental caries might reduce jaw tumor prevalence in Burkitt's lymphoma except among children ages 6-13 whose jaw marrow would unavoidably become infected by salivary EBV when the latter is present at the time of deciduous tooth loss.

Burkitt Lymphoma↗
PubMed1990

Replantation: an analysis of 29 teeth.

The results of replantation of 29 teeth are described. Maxillary incisors constituted 85% of 27 permanent teeth. The period between avulsion and replantation ranged from within an hour to 86 days, but the actual extraoral period was within 5 hours in all but one case. Nineteen of the 27 permanent teeth were functioning for 7 months to 6 years and 7 months postoperatively. Root resorption was the cause of tooth loss in five cases. The incidence of root resorption seemed to increase with the increase of the extraoral period, but it was not affected by the period between avulsion and replantation, the condition of supporting tissues, the degree of root formation, and the type and period of splinting, indicating multiple factors involved in determining the prognosis of replanted teeth. In conclusion, every effort should be made to preserve avulsed teeth even in unfavorable conditions.

Adolescent↗
PubMedDate not supplied

Outcomes for root-fractured permanent incisors: a retrospective study.

PURPOSE: The objective of this study was to assess the outcomes for treated root-fractured permanent incisors with respect to pulp vitality, root tissue union, and tooth survival and to examine the effects of clinical and radiographic parameters and rigid splinting on the outcome. METHODS: Eighty-four teeth were identified and data extracted from case notes prior to transfer to an SPSS data base for analysis. The odds ratios for each factor were calculated and the significance of differences was determined. Tooth loss and relevant risk variables were examined using Cox's regression model and Kaplan-Meyer survival curves. RESULTS: Fourteen (17%) had fractures in the apical third, 47 (56%) in the middle third, and 23 (27%) in the coronal (gingival) third. Twenty-four (29%) also had crown fractures involving enamel and dentine. Crown fractures were identified as significant risk factors for pulp vitality. Loss of pulp vitality, horizontal displacement, and extrusive displacement of the coronal fragment were significant risk factors for hard root tissue union. Survival was poorest with gingival third fractures with 14 (61%) of these teeth being lost. Splinting rigidly had no significant effect on pulp vitality and type of root tissue healing. CONCLUSIONS: Loss of pulp vitality was significantly associated with enamel-dentine crown fracture. Hard root tissue union was significantly affected by pulp necrosis and luxation of the coronal fragment. Survival was poorest for root fractures within the gingival third of the root. Splinting with rigid fixation had no significant effect on pulp vitality and type of root tissue union.

Adolescent↗
PubMed2004

Orthodontic and periodontal considerations in managing teeth exhibiting significant delay in eruption.

AIM: Significant delay in tooth eruption may be observed in many orthodontic patients. This delay may lead to complications, such as devitalization, ankylosis, external root resorption, injury to the adjacent teeth, and mucogingival problems. These complications may result in prolonged treatment time, esthetic deformities, damage to the periodontal tissues, and tooth loss. This report investigates the special considerations needed in treating such cases. METHODS: Combined orthodontic and surgical treatment can be used in managing teeth exhibiting significant delay in eruption. RESULTS: A high rate of success can be achieved in terms of esthetics, occlusion, and periodontal health. CONCLUSION: Nontraumatic surgery, adequate control of gingival inflammation, and use of minimal orthodontic forces may ensure a higher percentage of success and prevention of problems associated with teeth exhibiting significant delay in eruption.

Dental Occlusion↗
PubMed1996

Mandibular ramus flexure: a new morphologic indicator of sexual dimorphism in the human skeleton.

In the skeleton, male and female characteristics lie along a continuum of morphologic configurations and metric values. Size alone is not the best indicator of sex. In contrast, morphologic differences that arise from genetically sex-linked growth and development allow better separation of the sexes. This study presents a new morphologic indicator of sexual dimorphism in the human mandible. A sample of 300 mandibles from adults of known sex primarily from the Dart collection was analyzed. Of these, 100 were found to have obvious bony pathologies and/or excessive tooth loss ("pathologic" sample). Thus, the normative sample consisted of 200 individuals (116 males, 84 females). Examination of morphologic features led to the discovery of a distinct angulation of the posterior border of the mandibular ramus at the level of the occlusal surface of the molars in adult males. Flexure appears to be a male developmental trait because it is only manifest consistently after adolescence. In most females, the posterior border of the ramus retained the straight juvenile shape. If flexure was noted, it was found to occur either at a higher point near the neck of the condyle or lower in association with gonial prominence or eversion. In the normative sample, overall prediction accuracy from ramus shape was 99%. When the "pathologic" sample was analyzed separately, 91.0% were correctly diagnosed. Because the African samples were overwhelmingly black, this trait was also tested on American samples (N = 247) of whites (N = 85), Amerinds (N = 66), and blacks (N = 96) that included a mix of healthy individuals and those with extensive tooth loss and evidence of pathology. The results were nearly identical to those of the "pathologic" African sample, with accuracies ranging from about 91% in whites and blacks to over 92% in Amerinds. Total accuracy for all African and American samples combined (N = 547) is 94.2%. In conclusion, at 99%, sexing from the shape of the ramus of a healthy mandible is on a par with accuracy attainable from a complete pelvis. Moreover, there is no record that any other single morphologic or metric indicator of sex (that has been quantified from the adult skeleton) surpasses the overall accuracy attained from the more representative mixed sample produced by combining all groups assessed in this study. The usefulness of this trait is enhanced by the survivability of the mandible and the fact that preliminary investigations show that the trait is clearly evident in fossil hominids.

Animals↗
PubMed1991

[Evaluation of socio-economic status of the orthognathous and disgnathous school age examinees].

Purpose of this investigation is verification of socio-economic status of two orthodontic groups of examinees, to find out differences and similarities between them. Out of total sample of 640 elementary school age children, 320 are orthognathous (E) and 320 disgnathous (D). The disgnathous subjects have a specific malocclusion; early tooth loss or secondary crowding. According to their sex (male, female), orthodontic condition (E, D) and age (7-14 years) children are classified into 8 groups (each consisting of 20 examinees). Socio-economic status is assessed by using data on the occupation and education level (high = V, medium = S, low = Z) of the subjects' parents. A specific questionnaire is created for the technical performance of the investigation. The results are statistically analyzed and presented in tables. The data processing is made by using UNIVAC-1110 computer in FORTRAN system language. The parents of the orthognathous (E) children are mostly of a higher and high (V) education level as compared to the parents of the disgnathous (D) children who are mostly of a lower (Z) education level. The ratio is 54.3% E to 44.6% PS. The difference is statistically significant on the level of 0.05 (x2 = 6.04, df = 2). This might indicate that a higher level of parents' education contributes to a more successful influence of parents on the environmental factors which predominantly cause orthodontic anomaly of a premature tooth loss and secondary crowding.

Adolescent↗
PubMed1997

Spontaneous exfoliation of teeth following severe elemental mercury poisoning: case report and histological investigation for mechanism.

BACKGROUND: Although the spontaneous exfoliation of teeth and breakdown of oral tissues from severe mercury intoxication have been noted for over a century, there are no published reports investigating the mechanisms of these phenomena. Severe mercury poisoning is rare in modern times, but it does occur. We present a case report and a histopathologic investigation into the mechanism of the associated tooth loss. METHODS: An exfoliated tooth and periodontal and gingival tissues were obtained from a 15-month-old patient who had been severely intoxicated with elemental mercury over a period of months and hospitalized for severe neurologic and renal effects. The tissues were examined both by routine hematoxylin and eosin stain and by autometallography specific for mercury. For comparison, control tissue from an age-matched subject was examined with the autometallography technique. RESULTS: Under light microscopy, the gingival tissue showed evidence of moderate to severe acute and chronic inflammation. The tooth pulp tissue showed evidence of moderate vascular dilatation and congestion, and it was infiltrated by many neutrophils. The autometallographic sections showed intense accumulations of mercury in the soft tissues of the mercury-exposed subject, but not in the tissues of the control subject. The deposits were primarily found in fibroblasts, which are essential to maintaining the integrity of the oral tissues. CONCLUSIONS: Histopathologic and autometallographic examination of the affected tissue indicates that the primary mechanism of the spontaneous sloughing of tissue and loss of teeth may be the cytotoxic effects of the accumulation of mercury in fibroblasts. Studies of additional cases would be valuable to confirm this hypothesis.

Case-Control Studies↗
PubMed2005

Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects.

BACKGROUND: Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. OBJECTIVES: To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. SEARCH STRATEGY: We searched the Cochrane OHG Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of RCTs identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: May 2005. SELECTION CRITERIA: RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. MAIN RESULTS: Ten trials were included out of 29 potentially eligible trials. No included trial presented data after 5 years of follow up, therefore all data refer to the 1-year time point. A meta-analysis including eight trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.2 mm, 95% CI 0.7 to 1.7) and PPD reduction (0.8 mm, 95% CI 0.5 to 1.0) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had < 2 mm PAL gain in the control group, with RR 0.48 (95% CI 0.29 to 0.80). Approximately six patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 35%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating the only two trials at a low risk of bias in a sensitivity analysis, the effect size for PAL was 0.6 mm, which was less than 1.2 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed a statistically significant increase of REC (0.4 mm) and significantly more postoperative complications. No trials were found comparing EMD with BG. AUTHORS' CONCLUSIONS: One year after its application, EMD significantly improved PAL levels (1.2 mm) and PPD reduction (0.8 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition a sensitivity analyses indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD.

Alveolar Bone Loss↗
PubMed1999

Non-crown and bridge stabilization of severely mobile, periodontally involved teeth. A 25-year perspective.

It is the author's belief, after analyzing forces and stresses on the periodontium for more than 30 years, that stabilization of severely mobile teeth can retain teeth, if in health, almost indefinitely. Because these teeth are retained using restorative materials, recurrent caries is a problem that needs to be treated. Tooth loss resulting from caries can occur. In the author's 26 years of using extracoronal adhesive resins for splinting, the technology of adhesive bonding and restorative resins have been improved. Earlier shortcomings of the physical properties of these materials never dissuaded the author from recommending splinting. When the cases were presented to the patient and the referring dentist, the types of the current materials used to splint teeth were immaterial. Realizing that improvements in adhesives and resins would be developed, the near-hopeless teeth were retained. Because the elderly population is the fastest-growing segment of the population, caries control is more of a concern than it was 50 or more years ago. Because teeth are being retained longer in this cohort, and because caries has a greater potential to exist, supportive periodontal therapy and recalls and caries examination become more important.

Adhesives↗