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PubMed1996

Epidemiology of periodontal diseases.

This review summarizes findings from 46 reports selected from over 130 epidemiologic studies published in 1993 and 1994. Recent findings from longitudinal studies are consistent with the concept that periodontal destruction proceeds in random bursts at specific sites and demonstrate that some individuals have an elevated risk of attachment loss. These and other studies provide further evidence that cigarette smoking is a significant risk factor. New studies have quantified the risk of tooth loss due to periodontal disease, and there is better knowledge about HIV-associated periodontal diseases. Familial studies suggest that both environmental and genetic factors contribute to individual variations in etiologic factors (such as plaque) and periodontal diseases. Several studies propose an intriguing link between periodontal diseases and coronary heart disease, which may be mediated through risk factors common to both diseases, and as a direct consequence of the contribution of periodontal bacteria and their products to atherosclerosis.

Arteriosclerosis↗
PubMed2005

Smoking, a weak predictor of periodontitis in older adults.

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.

Aged↗
PubMed2003

Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT).

The subject risk assessment may estimate the risk for susceptibility for progression of periodontal disease. It consists of an assessment of the level of infection (full mouth bleeding scores), the prevalence of residual periodontal pockets, tooth loss, an estimation of the loss of periodontal support in relation to the patient's age, an evaluation of the systemic conditions of the patient and finally, an evaluation of environmental and behavioral factors such as smoking. All these factors should be contemplated and evaluated together. A functional diagram may help the clinician in determining the risk for disease progression on the subject level. This may be useful in customizing the frequency and content of SPT visits.

Age Factors↗
PubMed1998

The impact of the demographics of aging and the edentulous condition on dental care services.

Over the next 20 years, the number of people aged 65 years and older is expected to increase substantially in both Canada and the United States. Moreover, advances in dental treatment are resulting in reduced levels of the edentulous condition, such that there will be more people in need of various dental services. The purpose of this study was to determine what effect the increase in the overall population of the United States and Canada, and specific cohorts such as the senior citizen population, would have on the decrease in the levels of the edentulous condition. Through the use of population data obtained through Statistics Canada and the U.S. Census Bureau, it was determined that there will be 25.2% more Americans and 36.5% Canadians who are 65 years of age and over. Furthermore, an algorithm was developed using the United States national tooth loss data, which determined the percentage of people who would be edentulous at 75 years of age and older. The tooth retention rate improves with the younger age cohorts. The 50- to 54-year age group in the year 2000 will, on average, have 6.6 more teeth than the current elderly when they are 75 years of age and older. The percentage of the edentulous condition for the 75-plus age group will decrease by about 50% over the 35-year period from 1990 to 2025. The clinical significance of this trend means that there will be more people with more teeth in need of various dental treatments.

Adult↗
PubMed2004

Post-traumatic use of dental implants to rehabilitate anterior maxillary teeth.

The treatment sequel of post-traumatic teeth for the use of dental implants in the anterior maxillary region to rehabilitate anterior maxillary missing teeth was evaluated. Files of 53 healthy patients reporting anterior dental trauma were reviewed. All patients had an anterior maxillary dental implant because of tooth loss after trauma. At initial examination, 18 patients (34%) had root canal treatment and an inflammatory lesion, 15 (28.3%) had a missing tooth on admission, 12 (22.6%) had a prior operation (i.e. root-end surgery or crown lengthening), 4 (7.5%) presented an ankylotic root, and 4 (7.5%) had a root remnant not suitable for rehabilitation, with no inflammatory periapical lesion. Treatment sequences and complications were recorded. Augmentation procedure (i.e. onlay bone graft or guided bone regeneration) was performed in 43 patients (81.1%), and 2 patients (3.8%) had orthodontic extrusion prior to tooth extraction and implantation. Implants were placed immediately in 25 patients (47.2%) and 4 (7.5%) had immediate loading at the time of implantation. Complications and postoperative incidents (fistula, inflammation, swelling hematoma, etc.) were observed in 24 patients (45.3%). There was no difference in complication and postoperative incident rates with regards to the implantation technique. Complications were found at the prosthetic phase in seven patients (13.2%; six fistula and one implant failure). When patients were divided into two groups, with and without an inflammatory lesion, a significantly lower complication and postoperative incident rate were found in the non-inflammatory group (P = 0.057). This study reaffirmed the necessity for scrupulous diagnosis of teeth and alveolar bone after a traumatic injury. Treatment is multidisciplinary, requiring surgical, orthodontic, endodontic, operative, and prosthetic compliance. A specially designed treatment plan for each patient is necessary. General rules do not apply.

Alveolar Ridge Augmentation↗
PubMed1996

Oral health in alcohol misusers.

One hundred and seven chronic alcohol misusers (mean age 42.9 years; range 21-65 years; 80 males) attending four centres in South East London were interviewed on their current and past alcohol consumption. Their nutritional status (body mass index (BMI) and mid arm muscle circumference) was also recorded. Each subject completed a dental and oral mucosal examination. Ninety four per cent of the sample consumed greater than 50 units of alcohol per week and 80 per cent greater than 100 units of alcohol per week. Smoking and alcohol misuse were found to be related, 81 per cent reporting both habits. Neither plaque index scores or mean subject pocket depths were correlated with alcohol consumption but both were positively correlated with the frequency and duration of smoking. Overall mean DMFT was 15.4; age specific mean DMFT and tooth loss of the sample were closely similar to the 1988 United Kingdom adult dental health survey data. The prevalence and severity of tooth wear and attrition were greater in the sample than levels described in the literature and these dental features may prove useful markers to the practitioner. Trauma to teeth and oral mucosae was noted in 25 per cent of the sample. Seven oral mucosal lesions (including one treated carcinoma) were detected; mucosal trauma could have acted as a co-factor. Furthermore, 21 per cent of the alcoholics were malnourished (BMI < 20). It is concluded that, unlike several reports from the United States, dental health in this sample of alcoholics is not compromised; however mucosal health is a cause for concern.

Adult↗
PubMed2006

20-year follow-up of patients receiving high-cost dental care within the Swedish Dental Insurance System: 1977-1978 to 1998-2000.

The objective was to perform a long-term follow-up study of patients that had received high cost dental care within the Swedish National Dental Insurance System in 1977-1978 with special focus on remaining teeth, periodontal disease progression, change in the prevalence of root-filled teeth and teeth with apical periodontitis as well as the survival of fixed prosthetic reconstructions. All 262 patients who had had their treatment plans sent for approval for high-cost dental care in 4 local health insurance districts and who were sampled for base-line studies in 1977-1978, were offered a free clinical examination including radiographs in 1998. 177 patients (68 % of the original sample) could be reached for telephone interview and 104 of them (40 % of the original sample) were examined clinically and radiographically. Comparisons were made with records and radiographs from 1977-1978. The analyses were performed with the individual patient as the studied unit. The low progression of severe periodontal disease during the 20-23 year follow-up period and the decrease in number of teeth with apical periodontitis among a majority of the patients examined, indicated that the dental care received resulted in a limitation of dental disease on the individual level. Furthermore 63 % of the patients had the fixed prosthetic reconstructions, received after approval 1977-1978, in full extention after 20-23 years. However, more tooth losses were observed among the patients in this study than in similar studies in Swedish general populations over the same decades. Furthermore multiple tooth extractions were significantly more frequent in patients with severe periodontitis at baseline and in patients with less apical periodontitis at follow-up in this study. Thus it seems that tooth extraction not seldom was a treatment choice for teeth with severe periodontitis and apical periodontitis among the patients examined clinically in this study.

Adult↗
PubMed2000

Analysis strategies for longitudinal attachment loss data.

The purpose of this invited review is to describe and discuss methods currently in use to quantify the progression of attachment loss in epidemiological studies of periodontal disease, and to make recommendations for specific analytic methods based upon the particular design of the study and structure of the data. The review concentrates on the definition of incident attachment loss (ALOSS) and its component parts; measurement issues including thresholds and regression to the mean; methods of accounting for longitudinal change, including changes in means, changes in proportions of affected sites, incidence density, the effect of tooth loss and reversals, and repeated events; statistical models of longitudinal change, including the incorporation of the time element, use of linear, logistic or Poisson regression or survival analysis, and statistical tests; site vs person level of analysis, including statistical adjustment for correlated data; the strengths and limitations of ALOSS data. Examples from the Piedmont 65+ Dental Study are used to illustrate specific concepts. We conclude that incidence density is the preferred methodology to use for periodontal studies with more than one period of follow-up and that the use of studies not employing methods for dealing with complex samples, correlated data, and repeated measures does not take advantage of our current understanding of the site- and person-level variables important in periodontal disease and may generate biased results.

Disease Progression↗
PubMed1994

Diabetes--a risk factor for periodontitis in adults?

With the increasing number of diabetics in an aging population and controversial research reports on the relationship of diabetes to periodontitis, clarification of diabetes as a risk factor for periodontitis would be helpful. This review notes variations in type, metabolic control, and duration of diabetes and highlights the results of studies that have considered these variations. Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non-diabetics, although they had more periodontal pockets. Poorly-controlled diabetics with extensive calculus on their teeth had more periodontitis and tooth loss than well-controlled diabetics or non-diabetics. Long-duration diabetics were also at greater risk for periodontitis. Mechanisms by which diabetes may contribute to periodontitis include vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition. Minimizing plaque and calculus in the oral cavity through careful self-care and regular professional care is important to reduce the risk of periodontitis in diabetics.

Adult↗
PubMed2000

Enhanced interleukin 1 beta, interleukin 6 and tumor necrosis factor alpha in gingival crevicular fluid from periodontal pockets of patients infected with human immunodeficiency virus 1.

Loss of periodontal support and eventually tooth loss is a common finding among acquired immunodeficiency syndrome (AIDS) patients. The cause of this destruction may be an increase in periodontal disease activity at sites within the same individual and also may be related to an increase in the pro-inflammatory cytokines, diffused through the gingival crevicular sulcus in AIDS patients. A study was undertaken to determine the relative levels of the pro-inflammatory cytokines, interleukin 1 beta (IL-1 beta), IL-6, and tumor necrosis factor alpha (TNF-alpha), in gingival crevicular fluid collected from the deep (> 5 mm periodontal pocket depth) and shallow (< or = 3 mm periodontal pocket depth) periodontal pockets of 39 HIV-1-infected patients and 20 age-, race- and sex-matched uninfected controls. Complete medical history including risk factors such as intravenous drug abuse was taken. Gingival crevicular fluid samples were collected on periopaper strips. Cytokines were estimated by solid-phase enzyme-linked immunosorbent assay. To assess the degree of HIV activity, the viral load of these patients was determined by an Amplicor HIV-1 monitor kit using reverse transcriptase polymerase chain reaction. Gingival crevicular fluid from HIV-1-infected patients showed a two-fold increase in both IL-1 beta and TNF-alpha in deep periodontal pockets in comparison to shallow pockets, whereas IL-6 increased 1.8-fold. There was a significant (P < 0.05) increase in IL-1 beta, IL-6 and TNF-alpha in gingival crevicular fluid (both shallow and deep pockets) from HIV-1-infected patients in comparison to uninfected controls and also significantly elevated in deep versus shallow pockets in these patients. Although IL-1 beta, L-6 and TNF-alpha levels among HIV-1-infected patients with a high viral load (> 10,000 copies/ml) were higher than those from patients with a low viral load (< 400 copies/ml), only the increase in IL-1 beta level associated with deep pockets was significant (P < 0.05). There was also a trend of an increase in all the three cytokines among intravenous drug-abusing HIV-1-infected patients in comparison to non-intravenous drug abusers, but only the difference in IL-1 beta levels from deep pockets reached significance (P < 0.05). These enhanced pro-inflammatory cytokine levels in the gingival crevicular fluid of HIV-positive patients may be an important factor in causing the advanced periodontal lesions sometimes observed in HIV-positive patients.

Adult↗
PubMed2003

Longitudinal evaluation of GCF IFN-gamma levels and periodontal status in HIV+ patients.

BACKGROUND/AIM: Loss of periodontal support and related tooth loss is a common finding among HIV+ patients. The etiology of this destruction may be an increase in the levels of pro-inflammatory cytokines and subsequent increase in periodontal disease activity. The purpose of this study was to investigate the associations between gingival crevicular fluid interferon gamma (GCF IFN-gamma) and clinical measures of periodontal disease in HIV+ individuals. We monitored GCF IFN-gamma and periodontal status of selected sites in 33 HIV+ subjects over a 6-month period. METHOD: Clinical measurements including gingival index, plaque index, bleeding on probing, probing depth, attachment loss (AL), and GCF samples were taken from four lower incisors and the upper right posterior sextant of each patient at baseline and 6-month visits by means of sterile paper strips. GCF levels of IFN-gamma were determined by sandwich ELISA assays. A progressing site was defined as a site that had 2 mm or more AL during the 6-month study period. RESULTS: Twenty-five of the 264 examination sites showed 2 mm or more clinical AL during the 6-month study period. Significantly higher GCF levels of IFN-gamma were found at progressing sites than in nonprogressing sites (p < 0.001). GCF levels of IFN-gamma were highly correlated with clinical measurements taken at baseline and 6-month visits (0.001<p<0.01). CONCLUSION: These data indicate that sites with high GCF levels of IFN-gamma are at significantly greater risk for progression of periodontitis in HIV+ patients.

Adult↗
PubMed2004

Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation.

The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary.

Adult↗
PubMed2004

Management of chronic periodontal diseases within the NHS.

Studies estimate that up to 60% of tooth loss results from periodontal disease. Oral health awareness amongst the public has increased dramatically over the last decade and patients now place a great deal of importance upon tooth retention. Given the potential for premature mortality due to cardiovascular disease, the '20-per-day' smoker may contemplate giving up in 'the future'. However, when faced with the loss of an anterior tooth, they will contemplate immediate cessation and many succeed because the immediate consequences of not doing so are very tangible and personal.

Adolescent↗
PubMed1992

Root caries prevalence in black and white North Carolina adults over age 65.

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.

Aged↗
PubMed2001

A combination of a chemically modified doxycycline and a bisphosphonate synergistically inhibits endotoxin-induced periodontal breakdown in rats.

BACKGROUND: Chemically modified non-antimicrobial tetracyclines (CMTs) have been shown to inhibit pathologically elevated collagenase (and other matrix metalloproteinase, MMP) activity and bone resorption in vivo and in vitro. METHODS: In the current study, suboptimal doses of CMT-8 (a non-antimicrobial chemically modified doxycycline) and a bisphosphonate (clodronate, an anti-bone resorption compound) were administered daily, either as a single agent or as a combination therapy, to rats with experimental periodontitis induced by repeated injection of bacterial endotoxin (LPS) into the gingiva. At the end of the 1-week protocol, the gingival tissues were dissected, extracted, and the extracts analyzed for MMPs (collagenases and gelatinases) and for elastase, and the defleshed jaws were morphometrically analyzed for alveolar bone loss. RESULTS: LPS injection significantly (P<0.001) increased alveolar bone loss and increased collagenase (MMP-8), gelatinase (MMP-9), and elastase activities. Treatment of the LPS-injected rats with suboptimal CMT-8 alone or suboptimal clodronate alone produced slight reductions in the tissue-destructive proteinases and no significant reductions in alveolar bone loss. However, a combination of suboptimal CMT-8 and clodronate "normalized" the pathologically elevated levels of MMPs, elastase, and alveolar bone loss, indicating synergistic inhibition of tissue breakdown in this animal model of periodontitis. CONCLUSIONS: Combination of a CMT and a bisphosphonate may be a useful treatment to optimally suppress periodontal destruction and tooth loss and in other tissue-destructive inflammatory diseases such as arthritis.

Alveolar Bone Loss↗
PubMedDate not supplied

The importance of dental implants.

Implant dentistry has evolved into the mainstream of restorative practices all over the world. Maintenance of bone after tooth loss to improve or maintain facial esthetics and improved retention, function, and performance of removable restorations are only some of the advantages for the edentulous patient. No longer are implants considered only when traditional restorations cannot be fabricated. Evidence-based reports indicate implant restorations last longer than those on teeth and the abutment teeth are at less risk of loss or complication.

Adult↗
PubMed2004

Periodontal conditions in Switzerland at the end of the 20th century.

AIM: To epidemiologically assess the periodontal conditions of the adult population in Switzerland. MATERIAL AND METHODS: During a ten-year period, a total of 1318 subjects were randomly selected on the basis of a process involving the community rosters in seven regions (Cantons) of Switzerland: (Canton of Berne; Canton of Zurich; Western cantons (GE,VD,NE); Eastern cantons (SG,AI,AR,TG,SH); Southern cantons (VS,GR,TI); Central cantons (LU,GL,ZG,UR,SZ,OW,NW) and Northern cantons (JU,FR,SO,AG,BL)) and encompassing all adult age groups (20-89 years). The subjects were examined in dental offices randomly distributed throughout the country. The number of teeth present, the mean Plaque and Gingival as well as Retention Indices were assessed. Furthermore, pocket probing depths and loss of periodontal attachment were determined on all teeth. RESULTS: Ninety-four (7.1%) of the subjects were completely edentulous leaving 1224 dentate individuals with an average of 21.65 teeth for analysis. In the youngest cohort (20-29 years) 27.03 teeth were present. During the fourth to the seventh decade of life, tooth loss appeared to follow a linear pattern leaving 17.63 teeth in the age group of 60-69 years. The oldest age group of the 80-89 years old yielded 11.08 teeth. The mean scores of all clinical parameters increased significantly with increasing age. Mean PII in the youngest age group was PII: 0.72 (SD: 0.38) and reached PII: 1.55 (SD: 0.68) in the oldest. The corresponding mean GI were 1.17 (SD: 0.31) and GI: 1.64 (SD: 0.50), respectively. The mean RI increased from 0.24 (SD: 0.29) to RI: 1.34 (SD: 0.70) in the oldest. Mean probing depth increased slightly from 20 to approximately 49 years. Thereafter, mean PPD remained around 3.0 mm. The loss of periodontal attachment increased dramatically after the age of 50. CONCLUSIONS: Periodontitis manifests itself after the age of 50. The pronounced progressive attachment loss in the age cohorts over fifty years explained the marked loss of teeth in some individuals. From a public health point of view, it is indicated to make a major effort for periodontal prevention in the population approaching the second third of life.

Adult↗
PubMed1998

The tooth reduction and abrasion in a group of elderly home residents.

The degree of tooth loss and abrasion was the objective of the study on a group of 73 partially dentate elderly home residents, with particular interest in the type of missing and abraded tooth and the type of the interocclusal contacts according to the Eichner classification. The patients were examined by a dental mirror and a probe. The obtained data of dental status as well as medical and dental history were recorded in a specially designed questionnaire according to the WHO recommendations. The results confirmed the hypothesis about the molars being the most commonly missing teeth, with average values of 4.49 present teeth in lateral section and 5.82 present teeth in frontal section of the dental arch. The Eichner index class III was the most often interocclusal relationship found within 74% of the elderly home residents. Lower teeth were abraded more often than the upper teeth, showing higher abrasion degrees (class 2 and 3).

Aged↗