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PubMed1996

Estrogen replacement therapy in the elderly.

A woman spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Since the 1970s, we have evaluated the long-term risks and benefits of ERT in one population of women, the Leisure World retirement community. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures about 50 %. The effect is greatest in long-term users but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users retain more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40 %. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. A most feared aspect of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk both increaseng dose and decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation. The most important potential risk of ERT is breast cancer. In Leisure World, women who had used a total accumulated estrogen dose of 1500 mg or more had nearly twice the risk of breast cancer compared with nonusers. Short-term low-dose users showed no substantial increased risk. The Leisure World Study shows risks and benefits of ERT similar to other reports in the literature. For postmenopausal women generally, the benefits of ERT--preventing osteoporotic fractures, reducing heart disease, decreasing mortality, and possibly reducing risk of Alzheimer's disease-out-weigh the risks of endometrial and breast cancers. A woman must be fully informed of the risks and benefits of hormone therapy and play an important role in deciding whether to take hormones and which regimen to use.

Adult↗
PubMed2002

[Origin and treatment of bad breath].

Halitosis affects more than 60% of the population. In about 8% of the cases, halitosis is related to an ENT pathology, and in less than 1% to gastric dysfunction. Ninety percent of these problems are associated to an oral disease. Gram-bacteria are often responsible of bad breath. They transform some amino-acids in volatile sulphur compounds. These bacteria are, also, directly associated with periodontal diseases which affect a major part of the adult population. These diseases are the most important cause of tooth loss after the age of thirty-five, with progressive destruction of supporting tissues of the teeth.

Adult↗
PubMed1998

A dental implant: aluminium trioxide exhibited no effect on mouse reproductive and mutanogenic potential.

Several diseases as well as trauma can affect the composition and integrity of periodontal tissues leading eventually to the destruction of connective tissue matrix and cells, loss of attachment and resorption of alveolar bone, often followed by tooth loss. Replacement of the missing tooth could then be provided by endosseous dental implants healing in a form of osseo- or fibrosteal integration to the alveolar bone. Aluminium oxide ceramics, a form of endosseous implant, allows osseointegration type of healing and has demonstrated excellent biocompatibility. However, potential aluminium toxicity has been implicated in the pathogenesis of a number of clinical disorders and for this reason we examined the reproductive and mutagenic effect of aluminium trioxide ceramic implant in experimental mice. 720 female and 45 fertile male BALB-cAn NCR mice were included in the study. 3 experimental groups of fertile male mice (15 for each group) were treated with an intraperitoneal injection of aluminium trioxide (1 g/ kg of body weight, group I), with ethyl-methane-sulphonate as a positive control (200 mg/kg, group II) and with Tween-80 (10 mg/kg as a negative control, Group III). Each of the labeled male mice fertilized previously uncoupled female mice during 8 weeks (a pair per week) to facilitate appropriate pre- and post-meiotic conditions of spermatogenesis to occur. Female mice were sacrificed with cervical dislocation at day 13 after fertilization. Immediately upon sacrifice the uterus was removed and the number of alive and healthy, or alive but mutated and/or dead embryos was computed to determine the dominant lethal or mutagenic effect. Animals treated with aluminium trioxide demonstrated similar effects on the reproductive and mutagenic capacity as the negative control, whereas the animals treated as positive controls exhibited significantly reduced reproductive and mutagenic capacity. Collectively, we concluded that aluminium trioxide has a very low rate of embryonal mortality and mutagenicity in mice. This finding is in general agreement with the biocompatibility of aluminium trioxide as an implant material.

Aluminum Oxide↗
PubMed1998

Interleukin-1 and tumor necrosis factor antagonists inhibit the progression of inflammatory cell infiltration toward alveolar bone in experimental periodontitis.

Periodontal disease is a significant cause of tooth loss in humans and is one of the most prevalent diseases associated with bone loss. Following bacterial colonization, the gingiva becomes inflamed and, in some cases, progresses to destruction of alveolar bone. To investigate the temporal movement of inflammatory cells toward alveolar bone and the role of interleukin-1 (IL-1) and tumor necrosis factor (TNF) in this process, studies were carried out in a Macaca fascicularis primate model of experimental periodontitis. IL-1 and TNF activity was inhibited by local application of soluble receptors to IL-1 and TNF by injection into interdental papillae. The results indicate that following induction of experimental periodontitis, the front of inflammatory cells progresses toward alveolar bone and is associated with osteoclast formation. These processes are inhibited by blockers to IL-1 and TNF. These studies suggest that the conversion from gingivitis to periodontitis is directly associated with the movement of an inflammatory infiltrate toward alveolar bone, and that this activity is at least partially dependent upon IL-1 and/ or TNF.

Alveolar Bone Loss↗
PubMed2003

Public health and aging: retention of natural teeth among older adults--United States, 2002.

During the past several decades, the percentage of older adults who have retained their natural teeth has increased steadily. This trend is expected to continue, resulting in improved oral function and quality of life. To estimate the prevalences of tooth retention and total tooth loss in 2002 among adults aged >/=65 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that in 26 (52%) states, more than half of older adults reported having most (i.e., losing five or fewer) of their natural teeth. However, rates varied substantially among states and by selected characteristics. With tooth retention, older adults remain at risk for dental caries (i.e., tooth decay) and periodontal disease. To help adults maintain healthy teeth for life, community-based strategies should promote healthy behaviors, optimal use of fluoride, timely examinations and clinical services, and increased research into preventing oral diseases and promoting oral health among adults.

Aged↗
PubMed1998

Pathological bone changes in the mandibles of wild red deer (Cervus elaphus L.) exposed to high environmental levels of fluoride.

A macroscopic, microscopic and scanning electron microscope study was performed on the pathological bone changes of the mandibles of wild red deer (n = 61) exhibiting severe dental fluorosis. The animals originated from a highly fluoride polluted area in Central Europe (Ore mountains and their southern foreland, Czech-German border region) and constituted 11.2 % of the studied red deer sample (n = 545) from this area. Pathologically increased wear and fracture of fluorosed teeth caused a variety of mandibular bone alterations, including periodontal breakdown, periostitis, osteitis and chronic osteomyelitis. As a further consequence of severe dental attrition, opening of the pulp chamber and formation of periapical abscesses were occasionally observed. In case of severe periodontal breakdown, loss of teeth from the mandibles was found. In addition to the inflammatory bone changes, the occurrence of osteofluorotic alterations was also diagnosed in the specimens with the highest bone fluoride concentrations (> 4000 mg F-/kg dry wt). These changes comprised extended apposition of periosteal bone onto the mandibular cortex as well as deformation of the mandibular body, which was attributed to a fluoride-induced osteomalacia. The present study provided circumstantial evidence that, in addition to fluoride induced dental lesions, the occurrence of marked periodontal disease and tooth loss is an important factor responsible for a reduction of life expectancy in severely fluorotic wild red deer.

Animals↗
PubMed1994

Prevalence and natural history of periodontal disease in a London, Spitalfields, population (1645-1852 AD).

The periodontal health of an eighteenth century English population was investigated using a method of assessing the interdental septa for varying degrees of textural and architectural changes. It was found that, despite the fact that no effective dental treatment was available, the prevalence and distribution of periodontitis lesions were similar to those in modern English populations. The study confirmed the existence of susceptible and resistant subgroups of individuals and of teeth. The sixth decade appeared to have been a period of increased susceptibility to periodontitis. The findings do not support the view that periodontal disease is the primary cause of tooth loss in the uncared-for dentition.

Adolescent↗
PubMed2005

Oral health in patients on inhaled corticosteroid treatment.

OBJECTIVE: The aim of this study was to investigate the effects of long-term inhaled corticosteroids on bone mineral density (BMD) of the mandible in relation with the tooth loss. DESIGN: Cross sectional analytic study. SUBJECTS AND METHODS: Patients (n = 30) with chronic obstructive pulmonary disease under inhaled corticosteroid therapy for at least 1 year were compared with sex- and age-matched healthy controls (n = 30). BMD of the mandible was measured by dual-energy X-ray absorptiometry. The clinical examination included recording the number of teeth present together with periodontal condition. Levels of serum osteocalcin, alkaline phosphatase, calcium, phosphorus and cortisol were also assessed. RESULTS: BMD of the mandible in patients on corticosteroid treatment was significantly lower than that in the control group (P = 0.001). Patients under treatment had more missing teeth than the control group but the difference did not reach statistical significance. The two groups exhibited similar clinical parameters of periodontal condition. Significantly lower levels of osteocalcin (P < 0.0001), calcium (P = 0.004) and cortisol (P = 0.03) were observed in the patients on corticosteroid treatment. CONCLUSION: Long-term use of inhaled corticosteroids may impair bone metabolism and lead to a marked decrease in the mandibular BMD.

Absorptiometry, Photon↗
PubMed2003

Associations between self-reported dental status and diet.

The purpose of this study was to develop a battery of dental, nutritional and psychological health survey measures and to use this survey instrument to explore links between age, tooth loss and dietary risk. The survey was undertaken in a dental school and hospital. Forty-nine consecutive patients (age range 25-74 years) participated in this pilot study and completed the health survey instrument. A quarter of the patients reported changing dietary habits due to dental problems, 56% reported difficulty in chewing as a result of problems with their teeth or dentures, and 36% reported having to interrupt meals due to dental difficulties. Tooth number was associated with MNA scores (0.35, P=0.03, Pearson's correlation coefficient) and reported number of foods eaten (0.33, P=0.04, Pearson's correlation coefficient) from the questionnaire checklist. Lower MNA scores were associated with age (F=6.54; d.f.=1, 46; P<0.01) indicating that older adults were more at risk of poor nutritional status. Overall health was not rated as an important factor influencing food choice, and only 14% of the sample felt that they had nutritional problems. Poor diet and impaired food choice was associated with declining numbers of teeth and increasing age. Older adults may require dietary advice to increase awareness of the importance of a healthy diet.

Adult↗
PubMed1998

Bone grafting and its essential role in implant dentistry.

Pressure to deliver implant-born prosthetics in most partially edentulous situations is growing. The implant team is faced with high patient expectations for optimal function and aesthetics while being challenged to restore more complex areas of the jaw. Osseous ridge deficiencies are more often the norm than the exception following tooth loss. Squeezing short or narrow implants into deficient ridges is a poor technique that often fails to properly replace ridge anatomy or provide stable restorations. Bone grafting should assume an essential role to the implant team if their objective is to create biologically sound replicas of missing natural teeth.

Alveolar Bone Loss↗
PubMedDate not supplied

Medical conditions associated with missing teeth and edentulism in the institutionalized elderly.

Several studies have reported the prevalence of medical conditions or investigated the relationships between the oral health status and general health conditions in the elderly. However, the relationship between medical conditions and oral health among the elderly is not well-described. Previous studies have not clearly identified a consistent association between medical conditions and oral health, specifically edentulism and tooth loss. The purpose of this study was to investigate the relationships between medical conditions and oral health, as assessed by edentulism and missing teeth, in an institutionalized elderly population. A systematic sample (n = 175), stratified by age and sex, was drawn from nursing home patients treated by the University of low' as Geriatric Mobile Unit (GMU) team. Data were extracted from GMU dental records, regarding history of medical conditions, medications, dental history, dentate status, and tooth-by-tooth conditions. Mean numbers of missing teeth were significantly higher among those who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease. Subjects who had a history of atherosclerotic vascular disease, heart failure, ischemic heart disease, and joint disease were more likely to be edentulous than subjects who did not have a history of those diseases. The biological basis for these relationships between dentate status and systemic medical conditions is unclear and warrants further study.

Aged↗
PubMed1998

How dentition status and masticatory function affect nutrient intake.

The authors examined nutrient intake in relation to the number of teeth, denture type and masticatory function among 638 men in the U.S. Department of Veterans Affairs Dental Longitudinal Study. They found that calorie-adjusted nutrient intakes decreased with progressively impaired dentition status, independently of age, smoking status and alcohol use. Intakes of fiber and most vitamins and minerals were inversely correlated with masticatory function. The findings suggest that prevention of tooth loss and prosthodontic replacement of missing teeth could improve diets of older adults.

Adult↗
PubMed1991

[Periodontal epidemiology and the estimate of treatment needs].

This article reviews the present status on the prevalence and distribution of periodontal diseases in the population. The relationship between periodontal diseases and tooth loss is described. Epidemiological data have limitations when they are used to describe treatment needs in the population. Some of these limitations are discussed.

Adolescent↗
PubMed2003

[Oral condition of abstaining alcoholics. A case-control study].

The aim of this study was to investigate the oral situation of long-term severely alcohol-addicted persons in a case-control-study. 28 controlled abstinent alcoholics and 30 control persons without any drinking history but who were smokers participated in the study. The mean age of the patients was 46 years, the alcohol addiction had existed for 17 years on average; the majority were heavy smokers with an average of two packs of cigarettes per day. The mean age of the control persons was 43 years, each of them smoked about one pack of cigarettes per day. The oral examination included the DMF-T and the different components, the QHI, the PBI and the CPI. Significant differences between the two groups were found for the following parameters: M-T (p < 0.0002), DMF-T and D-T (p < 0.002), PBI (p = 0.05). F-T and QHI revealed no differences. The periodontal examination showed that in 69% of the alcoholics and in 40% of the controls severe pocketing could be found (CPI 4). 4% of the patients and 20% of the controls had no periodontal pockets (CPI 0, 1 or 2). These results indicate that long-term severely alcohol-addicted persons have a high risk of periodontal breakdown and tooth loss. They also support the assumption that excessive consumption of alcohol may promote the progression of chronic periodontal disease.

Adult↗
PubMed2004

Patient-based assessments of clinical periodontal conditions in relation to alveolar bone loss.

BACKGROUND: Limited subject-based information exists on the relationship between clinical and radiographic periodontal data. AIMS: To use subject-based data to assess the extent of concurrence between clinical and radiographic information, and to study what clinical information best predicts alveolar bone loss (ABL). MATERIAL AND METHODS: Subject-based data on smoking habits, bleeding on probing, plaque scores, pocket probing depth (PD), and evidence of alveolar BL were obtained, and functional periodontal pentagon risk diagrams (PPRDs) were studied from 168 consecutive subjects attending a medical clinic. RESULTS: The mean age of the subjects was 62.7 years (SD+/-9.0). The average number of teeth was 21.3 (SD+/-8.0) with on average 5.6 molars remaining (SD+/- 3.9). In this subject cohort, 33.1% had never smoked, 44.2% had quit smoking, and 22.7% were currently smokers. Mean plaque and bleeding scores were high or 60.2% (SD+/-24.0) and 53.1% (SD+/-23.6), respectively. PDs >or=6.0 mm were found in 55.9% of the subjects. Binary logistic regression analysis demonstrated that tooth loss and proportional plaque scores were the predominant factors included in the equations associated with ABL. Wald coefficients varied between 3.99 and 9.15, and with p-values between 0.05 and 0.01. When included, the PPRD score became the exclusive factor at several cut-off levels (Wald's coefficients between 19.8 and 15.6, p<0.001). Consequently, the best receiver operator curve was identified for the PPRD at the >40% cut-off ABL level (area under the curve: 0.81; 95% CI: 0.74-0.89; p<0.001). CONCLUSIONS: The number of teeth lost and the proportion of plaque scores provided significant predictive factors for ABL. The functional PPRD demonstrated an exclusive and highly predictable association with ABL. Subject-based proportional data for PDs >4.0 mm provided poor substitute measures for the extent of ABL.

Adult↗
PubMed1996

Stomatognathic dysfunctional symptoms in Saudi Arabian adolescents.

Secondary school Saudi students participated in a questionnaire about stomatognathic dysfunction symptoms. The adolescents were interviewed about general health, peripheral joint disease, chewing function, oral parafunctions, and symptoms of dysfunction. Thirty-two per cent of participants had at least one dysfunction symptom. Pain on opening was the most common (35.7%), followed by headache (33.6%), and joint sounds (32.2%). Symptoms increased with decline in general health, particularly the health of peripheral joints. Chewing functions were not impaired. Tooth loss did not affect dysfunction symptoms in adolescents, whilst a weak relation was evident between oral parafunctions and symptoms of mandibular dysfunction.

Adolescent↗
PubMed1990

[Periodontal atrophy and further findings in aging people].

In a group of 100 patients cared for in a dispensairy system ranging in age from 50 to 59 years with a total of 2122 teeth the following was found: 767 teeth with periodontal atrophy at the vestibulary side, 415 teeth with untreated defects of dental hard tissues in the region of the cemento-enamel-junction, 168 crowns, fillings and/or dental caries. Periodontal atrophy was not the cause of tooth loss; the treatment of secondary lesions could be a problem. As far as the possible etiological factors are concerned especially the exogenous factor toothbrushing could be influenced. An effective brushing technique is recommended.

Aged↗
PubMed2003

A pilot study on the oral conditions of severely alcohol addicted persons.

The aim of this study was to investigate the oral status, drinking, smoking, and oral hygiene habits of alcoholics. One hundred severely addicted alcoholics were examined during the in-patient treatment for detoxification (mean age: 44 years; 68 males/32 females) The study included a questionnaire and an oral examination that measured DMF-T, QHI, PBI, and CPI. The majority of alcoholics were heavy smokers (>30 cigarettes/day). Fifty-two percent of the alcoholics stated they frequently forgot to brush their teeth and 43% observed bleeding of their gums. The mean DMF-T was 20 (2 D-T, 9 M-T, 9 F-T), the mean QHI was 2.4, and the mean PBI was 1.8. Forty-nine percent of the sextants were scored CPI 3 or 4; about 25% were edentulous (CPI X). Our results indicate severe alcoholics have a high risk of periodontal break down and tooth loss. To what extent these findings were caused by general/oral neglect alone (in combination with nicotine abuse) is at present unknown.

Adult↗