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[Early loss of teeth after treatment for childhood leukemia].

BACKGROUND: Only few reports of effects of radiotherapy in childhood on the dental apparatus are available in the literature. The basis for early loss of teeth appears to be a reduction of the root surface area after radiation exposure. These effects in the periodontium are a consequence of combined radiochemotherapy usually applied for treatment of childhood neoplasia. Chemotherapy alone also results in changes of periodontal development. CASE REPORT: A 33-year-old patient is reported, who, at the age of 11 years, received high-dose chemotherapy and radiotherapy of neuroaxis and cranium for acute lymphatic leukemia with relapse. The patient consulted the Implant Section of the Department of Oral and Maxillofacial Surgery because of severe dental changes and tooth loss despite adequate dental care and oral hygiene. Radiation doses given to the superior maxilla and mandible at the age of 11 were estimated to be in the range of 8-25 Gy. CONCLUSION: Intense, life-long dental care and follow-up of patients cured from malignant disease in childhood must hence be postulated in order to minimize dental treatment sequelae by supportive measures, but also to initiate timely adequate dental and prosthetic management.

Adult↗

Periodontal disease in American Indians and Alaska Natives.

OBJECTIVE: The primary purpose of this paper is to provide information on the periodontal disease status of Native Americans using a variety of data sources. The impact of periodontal disease on the provision of dental care within the Indian Health Service (IHS) is also discussed. METHODS: Four data sources were used to evaluate the periodontal disease status of Native Americans: IHS periodontal disease monitoring system (1962-78), 1984 IHS Patient Oral Health Survey, 1990 WHO community-based survey (ICS-II), and the 1991 IHS Patient Oral Health Survey. RESULTS: There appears to be a trend toward a higher prevalence of incipient and overt periodontal disease among Native Americans over time. The prevalence of overt periodontal disease (periodontal pockets > 5.5 mm) is higher among Native American diabetic patients than nondiabetic patients (34% vs 19%). CONCLUSIONS: Due to the variety of indices used by the IHS during the last 20 years, it is difficult to make direct comparisons of the available periodontal disease data. However, it appears that the prevalence of periodontal disease among Native Americans is increasing. Type II diabetes accounts for significant increases in periodontal disease and tooth loss in Native American populations. Certain forms of early onset periodontal disease also may pose significant threats to the oral health of Native Americans.

Adult↗

Caries experience among publicly-funded dental patients in Australia, 1995-96: type of care and geographic location.

Health card holders are a financially disadvantaged group and are the target population eligible for publicly-funded dental care. While their health status is generally worse compared with other Australians, there is also considerable variation among card holders. The aims of this study were to describe the oral health status of publicly-funded dental patients by type of care, geographic location and age, and to compare trends over time against other Australian studies. Patients were sampled randomly, based on date of birth, by State/Territory dental services in 1995-96. Dentists recorded oral health measures at the initial visit of a course of care using written instructions, but there was no formal calibration. The 6109 patients sampled were weighted in proportion to the numbers of publicly-funded dental patients for each State/Territory. Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p < 0.05). For rural compared with urban patients, mean numbers of decayed and filled teeth tended to be higher. For emergency compared with non-emergency care, mean numbers of decayed and missing teeth were higher, and filled teeth lower. The findings of this monitoring survey document high levels of previous disease and treatment and indicate variation between subgroups of users of publicly-funded dental care. This included an uneven geographic distribution of oral health and disease, and variation in unmet treatment needs by type of course of care. Temporal comparisons indicate publicly-funded patients have experienced the population trend towards lower levels of tooth loss over time but have higher levels of untreated decayed teeth compared with the general population.

Adolescent↗

Long-term evaluation of endodontic and periodontal treatment.

One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodontal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive supportive periodontal treatment.

Adult↗

Clinical morbidity and sequelae of treatment with complete dentures.

Wearing complete dentures may have adverse effects on the health of both the oral and the denture-supporting tissues. This article is a review of selected literature on the sequelae of treatment with complete dentures in the specific areas of residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction. Recent literature found with a Medline search from 1952 to 1996 is included in this review. Residual ridge resorption is an inevitable consequence of tooth loss and denture wearing, with no dominant causative factor having been found. Mucosal reactions have a multifactorial cause, most of which can be easily treated. Most patients are satisfied with their complete dentures. Correlations between anatomic conditions and denture quality and patient satisfaction are weak. Psychologic factors seem to be extremely important in the acceptance of and adaptation to removable dentures. There are still no reliable methods to predict the outcome of complete denture treatment and there are many problems related to treatment with complete dentures. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical research on removable partial dentures. Complete denture prosthodontics will remain an important part of dental education and practice. In addition to clinical and technical skills, insight into patient behavior and psychology and communication techniques are also necessary.

Adaptation, Physiological↗

[Health problems of the stomatognathic system in the Polish population covered by stomatological health care. Place of residence and work].

The condition of the stomatognathic system was studied in 5682 adult patients attending stomatological care services in regional outpatient clinics, health service centres, and industrial health service units in 6 provinces. Most frequently, the patients came to these services with emergency symptoms. Poor state of teeth was observed in all these service units, but the worst oral hygiene and the highest percent of parodontal diseases were found in industrial health service institutions. In this group tooth loss was most frequent. These results indicate that the stomatological health care in industrial service units despite an above average equipment of dental care rooms, better availability of dental care, and sufficient staffing is not better than in the stomatological care units available to the general population.

Dental Health Services↗

Acrylic partial dentures.

Acrylic removable partial dentures are routinely used in everyday clinical practice. However, there is concern that if they are not correctly designed that damage may result to the soft and hard tissues leading to tooth loss. This article reviews the potential damage that may occur from the use of acrylic dentures. Methods of improving the design features and construction of acrylic RPDs to minimize damage and improve longevity of the remaining teeth will be demonstrated.

Acrylic Resins↗

[Oral health status and dental care of the elderly population].

There is a growing interest in the oral health status of older persons 65+ years as the size of this population increases and the percentage of edentulous persons decreases as a result of the prevention in younger ages. The provision of dental care in the elderly patient is basically the same as the care provided to other segments of the population. Yet there are problems related to their mental and physical health which should be taken into account. In this paper some information was given about the dental caries, periodontal diseases, oral mucosa diseases and tooth loss in the elderly population as well as about the dental treatment and prevention of dental services and the factors that affect it are referred. Further, some recommendations for the improvement of oral health of the elderly in Greece were done.

Aged↗

[Renewed examination of the group classification of partially edentulous arches by Eichner and application advices for studies on morbidity statistics].

The groups A1 to C3 of the "group classification of partially edentulous arches" by Eichner are characterized by the number of teeth and the topography of the natural dentition. This could be demonstrated in a clinical study on 1000 patients prepared by Blume-Gréger. The result shows a percentage of 49.5 in the groups A, 22.4% in the B-groups and 28.1% in the C-groups. Furthermore, these groups represent the course of tooth loss also regarding the functional value of the natural dentition. Thus, this classification provides a standard for the degree of morbidity of the dentition and is suitable for application in studies on morbidity statistics. When used for documentation files there is an error possibility of 1.9%.

Adult↗

Denture satisfaction and clinical performance in a paediatric population.

OBJECTIVES: The objectives of this study were to investigate the clinical performance of partial upper dentures in children and to assess reported denture satisfaction in this young population. DESIGN: This was a retrospective study using patients' dental records in conjunction with a postal questionnaire. SETTING: The Paediatric Dentistry Clinic, School of Clinical Dentistry, Sheffield. SAMPLE AND METHODS: Fifty-eight children (aged 7-17 years) who had been provided with a partial upper denture to replace one or more missing permanent incisors were included in the study. The patients' dental records were examined for the following details: tooth type missing, presence of retained incisor roots, aetiology of tooth absence, age at which the denture was first provided, total time period dentures had been worn, and frequency and type of any denture repairs or replacements. Next a short questionnaire was sent to each child, which sought an evaluation of several parameters of denture satisfaction including: overall attitude towards wearing a denture, denture appearance, ease of eating, comfort and perceived degree of teasing from peers. Visual analogue scales (VAS) were employed to provide a graded response. RESULTS: 70.7% of subjects had a single missing incisor and trauma was the most common cause of tooth loss (77.3%). The mean age at which patients started wearing a denture was 11.6 years and the mean length of time dentures had been worn, at the time of the investigation, was 2.1 years. A 'T-shaped' denture was most commonly employed (77.5% of dentures). Overall, 36.2% of subjects had required at least one denture repair, 28.2% presenting within a year of denture provision. One or more denture replacements had been received by 60.3% of the patients, and 43.6% had required this within a year. Component failure was highest for the denture tooth (40% of repairs) and a change in the patient's dentition necessitated a denture remake in 66% of cases. VAS scores for parameters of denture satisfaction indicated an overall positive evaluation of the dentures, with the most positive response relating to ease of eating. However, the reported degree of teasing was high and increased with time. The only significant difference for denture satisfaction according to gender was for mastication: girls reportedly found eating easier than did boys. CONCLUSION: Children are generally accepting of upper partial dentures, but their poor clinical performance is of concern and there is need for improvement.

Adaptation, Psychological↗

Dental and periodontal status and risk for progression of carotid atherosclerosis: the inflammation and carotid artery risk for atherosclerosis study dental substudy.

BACKGROUND AND PURPOSE: Dental and periodontal disease are potentially involved in the pathogenesis of atherosclerosis. We investigated whether dental and periodontal status is associated with the presence and future progression of carotid stenosis. METHODS: We randomly selected 411 of 1268 participants from the prospective Inflammation and Carotid Artery Risk for Atherosclerosis Study and evaluated dental and periodontal status and oral hygiene at baseline measuring three World Health Organization-validated indices: DMFT (decayed, missing, filled teeth), SLI (Silness-Löe Index), and CPITN (community periodontal index for treatment needs), respectively. The degree of carotid stenosis was measured by duplex ultrasound at baseline and after median 7.5 months (range=6 to 9 months) to identify patients with progressive carotid stenosis. RESULTS: DMFT (P<0.01), SLI (P=0.048), CPITN (P=0.007), and edentulousness (P=0.007) were associated with the baseline degree of carotid stenosis. Atherosclerosis progression was observed in 48 of 411 patients (11.7%). DMFT (adjusted odds ratio [OR]=1.11, 95% CI=1.01 to 1.22, P=0.032) and SLI (adjusted OR=1.77, 95% CI=1.09 to 2.79, P=0.021), but not CPITN (adjusted OR=1.51, 95% CI=0.89 to 2.45, P=0.16) were significant predictors of disease progression, irrespective of traditional cardiovascular risk factors and the baseline degree of stenosis. Edentulous patients had a significantly increased risk for disease progression as compared with patients with teeth (adjusted OR=2.10, 95% CI=1.06 to 4.16, P=0.33). CONCLUSIONS: Dental status, oral hygiene, and particularly tooth loss are associated with the degree of carotid stenosis and predict future progression of the disease.

Aged↗

Provision of extractions by main diagnoses.

AIMS/OBJECTIVES: The aim of this study was to investigate the association of extractions by the diagnoses of caries, pulpal/periapical infection and periodontal disease, controlling for visit type, insurance and age. DESIGN: Cross-sectional analysis of the 1993-94 wave of a longitudinal study. SETTING: Private general dental practice. PARTICIPANTS: A random sample of Australian registered dentists, (response rate = 74%). METHODS: Practitioners completed service logs over one to two typical clinical days. MAIN OUTCOME MEASURE: Percentage of patients receiving extractions. RESULTS: Overall, 7.05% of patients received extractions, with the highest percentages occurring for persons with caries (7.90%), periodontal disease (17.45%) and pulpal/periapical infection (17.54%). Odds of extraction were higher at emergency visits for insured and uninsured patients compared to non-emergency visits by insured patients, while odds of extraction (Logistic regression: OR = Odds ratio; 95% CI) were higher for 18-44 year-olds with caries (OR = 1.44; 1.09-1.89), for 18-44 (OR = 1.84; 1.34-2.54) and 45+ year-olds (OR = 1.83; 1.27-2.63) with pulpal/periapical infection, and for 45+ year-olds (OR = 6.82; 4.68-9.95) with periodontal disease. CONCLUSIONS: There were different age-specific causes of extraction, controlling for visit type and insurance. Effect sizes were highest for pulpal/periapical infection and periodontal disease, but caries remained a major cause of tooth loss due to the higher prevalence of this condition.

Adolescent↗

Use of shell crowns in Hong Kong dental hospital attenders.

In 1984 an oral health survey of Hong Kong adults aged 35-44 years revealed that 15% of subjects presented with metal shell crown restorations, often as components of fixed-bridge reconstructions. The aim of this study was to describe the patterns and means of use of shell crowns, and to describe the patterns of tooth loss in patients who presented with such restorations, attending for treatment at the dental teaching hospital in Hong Kong over a 2-year period. A total of 1563 such patients attended. The records, which included radiographs, of 165 of these patients aged 35 years and above, obtained by means of a systematic sampling frame, were studied by one trained examiner. On initial presentation each patient was found to have a mean of 4.0 shell crowns, 77% of these being components of bridge restorations. The bridges involved a mean of only 3.9 units (retainers and pontics). The tooth type most commonly replaced by a bridge of this type was the first molar. It was concluded that most shell crowns used in this patient group are abutment retainers for predominantly short-span bridge restorations.

Adult↗

A follow-up case report of Actinobacillus actinomycetemcomitans in human periodontal disease.

The purpose of this investigation was to compare clinical and microbial parameters in a follow-up case report of adult subjects harboring Actinobacillus actinomycetemcomitans (Aa) with clinically matched subjects who did not have detectable Aa. 16 subjects with Aa and 16 subjects without Aa at the baseline examination were re-examined at an average of 46 months following collection of baseline data. Clinical measurements were recorded and subgingival plaque sampled and evaluated for microbial flora from each maxillary first molar. In 16 subjects with Aa at baseline, 4 sites in 3 subjects had detectable actinobacilli at the follow-up appointment. 26 sites in 13 individuals with Aa at baseline had a significantly increased gingival index at the follow-up visit (p less than or equal to 0.05), but there was no significant increase in probing depth or attachment loss. 32 sites in the 16 subjects without Aa at baseline still did not have detectable levels of this microorganism at the follow-up examination nor was there any significant difference between baseline and the follow-up appointment for the gingival index, probing depth and attachment level measurements. In subjects with Aa at baseline, 1 of 12 teeth without Aa and 5 of 20 teeth with Aa had been extracted prior to the follow-up visit. In this population group, having sites where Aa was detected, 6 of 9 teeth which had a probing depth greater than or equal to 5 mm were lost before the follow-up data collection appointment. In the control group, which did not have detectable Aa at baseline, 9 teeth with probing depths greater than or equal to 5 mm were not lost. These observations, although not proving, suggest in this population group, that deeper probing depths taken together with the presence of Aa may have placed an individual at greater risk of tooth loss.

Adult↗

A 5-year follow-up study on the prosthetic rehabilitation of the elderly in Helsinki, Finland.

In 1990, 364 elderly (76-86 years) inhabitants of Helsinki, Finland, attended a dental and oral examination study that was conducted as part of the Helsinki Aging Study. In spring 1996, these subjects were recalled for a 5-year follow-up. Between the baseline and follow-up examinations, 114 (31%) subjects had deceased (86 women and 28 men), whereas 134 had either moved, were too ill, or refused to participate in the follow-up. Follow-up examination was conducted for 113 subjects (79 women and 34 men), with the participating rate being 46%. Five subjects became edentulous during the follow-up. Of the subjects, 61% had 1-32 teeth at follow-up. In these subjects, the mean number of teeth decreased from 14.9 (+/-8.3) to 13.5 (+/-8.6) (P < 0.0001). Prosthetic status changed in 40% of the elderly dentate people: 25% received new prostheses whereas 15% lost prostheses that were not replaced. New fixed partial dentures were made in five maxillae and in nine mandibles during the follow-up. Acrylic removable partial dentures (ARPD) were most frequently used: 35% of dentate subjects had an ARPD. Subjects with removable prostheses had higher levels of salivary microbes and higher root caries incidence than those with natural teeth. Furthermore, the presence of removable prostheses at baseline, together with the male gender, was clearly associated with tooth loss during follow-up. This study indicates that fixed rather than removable prostheses should be used in elderly patients. The need for a removable denture ought to be carefully considered.

Aged↗

A single dimension statistical evaluation of predictors in implant-overdenture treatment.

This retrospective study aims to identify factors that contribute to either a poor or excellent treatment result in implant-overdenture treatment. A total of 375 implants, in an equal number of patients were included in the study. A clinical examination was performed by 2 observers. Gingival health and oral hygiene were assessed and additional complications were noted, including implant loss. 2 outcome variables, STATUS1 and STATUS2, were constructed that were different with respect to treatment outcome, representing a poor and an excellent result, respectively. Patient variables such as age, gender, medical status and prosthetic history were collected pre-operatively with a questionnaire. Life table analyses were used to test subsets of patient and treatment variables for differences in survival distribution, both for poor or excellent results. With regard to predictors of poor results; implants in the upper jaw were associated with a poorer outcome than those placed in the lower jaw (p = 0.01). When more than 2 implants were placed, the quality of survival was also impaired (p = 0.03). Interestingly, implants in patients with a self-proclaimed history of tooth loss due to periodontitis appear to have a far poorer treatment outcome than implants placed in patients without such a history (p = 0.01). No other variables could be related to a poor result after 3 years. None of the variables could predict an excellent treatment outcome.

Age Factors↗

Association of bite force with ageing and occlusal support in older adults.

OBJECTIVES: The purpose of this study was to investigate the effect of ageing, occlusal support and TMJ condition and general health status on bite force in older adults. METHODS: The study sample consisted of 850 independently-living people over the age of 60 years. Bilateral maximal bite force in the intercuspal position was measured with pressure sensitive sheets. TMJ noise by palpation and limitation of mouth opening (less than 40 mm) were assessed. Subjects were grouped into three categories by occlusal support according to the Eichner Index. RESULTS: A multiple logistic regression analysis showed that whether participants had low bite force or not was significantly associated with gender, age, self-rated general health and occlusal support, but not TMJ noise or mouth opening limitation. Overall bite force showed a statistically significant but weak negative Spearman's correlation with age (r=-0.24, p<0.001). However, there was no significant correlation between age and bite force in the Eichner C group for males or in any of the Eichner classification for females. CONCLUSIONS: Decline of occlusal support and general health might translate into reduction of bite force with ageing in older adults. Since tooth loss is not physiological ageing but pathological ageing, it cannot be shown that reduction of bite force is a natural effect of ageing.

Age Factors↗

Munchausen syndrome by proxy: unusual manifestations and disturbing sequelae.

Since the initial description of Munchausen Syndrome by Proxy (MSBP) (Meadow, 1977), numerous cases have been reported varying from as simple as the complaint of a nonexistent symptom to those as complicated as altered laboratory tests leading to the false diagnosis of cystic fibrosis (Orenstein & Wasserman, 1986; Rosenberg, 1987). We report three findings previously unreported: esophageal perforation, retrograde intussusception, and tooth loss. Bradycardia has been previously reported associated with suffocation (Meadow, 1984), but in our case may have been caused by carotid artery massage. We also suggest possible induction by the mother of premature rupture of fetal membrane leading to delivery of infected infants.

Bradycardia↗