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A survey of dental disease in children of Wuvulu Island, Papua New Guinea.

A convenience sample of 153 boys and girls, aged 3-16 years, inhabiting Wuvulu Island were examined for the prevalence of dental caries and periodontal disease and for oral hygiene status. Average df teeth and surface scores for the group were 2.08 and 3.35, respectively, while average DMF teeth and surface scores were 0.90 and 1.20, respectively. Of the sample, 30.7% were caries free. Oral hygiene was poor and males had significantly more periodontal disease than females. While primary teeth were about three times more susceptible to caries than permanent teeth, tooth loss due to caries was not a problem in primary teeth. The authors discuss findings of other researchers and reasons for the greater prevalence of caries in primary teeth.

Adolescent↗

The mandible--an analysis.

In this study, an attempt has been made to examine and analyse the ancient mandibles of people who have died several hundreds of years ago during the second and first millenium B.C. These mandibles have been recovered from the burial mounds in Bahrain (Arabian Gulf) and preserved in the National Museum and the Department of Antiquities in Bahrain. The dental conditions recorded are e.g. attrition, caries, fluorosis, periodontitis or antemortem tooth loss. The results indicate the age, sex, diet, occupation and environmental conditions that existed and even the culture of the people. A comparative study of the ancient mandibles and those of the present generation has been carried out.

Adult↗

[Orthodontic abnormalities of deciduous and permanent occlusion].

The aim of this study was to examine the trend in orthodontic anomalies for the period from primary to permanent dentition. 246 examinees (132 boys and 114 girls) with orthodontic anomalies were examined for the first time at the age of 4.5-5.5. These examinees were reexamined by the same orthodont at the age of 12.5-13.5. No orthodontic procedures were performed with the children in the meantime. From the period of primary to permanent dentition, 16.3% of orthodontic anomalies developed into eugnathia. During this period, the incidence of Class II Division I anomalies, premature tooth loss and open bite significantly decreased, and the incidence of Class II Division 2 and crowding increased. From primary to permanent dentition 63.4% orthodontic anomalies altered, and 36.6% remained with a stabile diagnosis.

Adolescent↗

Tooth splinting for severely mobile mandibular incisor teeth in a dog.

Periodontal disease, in its advanced stages, causes tooth mobility. The tooth movement further damages the periodontium, accelerating the disease process leading to tooth loss. Dental splinting can provide coaptive stability to the teeth as an important component of a periodontal treatment plan. This report documents results four years following splinting of the mandibular incisor teeth in a 3 year old Miniature Schnauzer dog.

Animals↗

The Class V lesion--aetiology and restoration.

The aetiology of non-carious cervical lesions is discussed. These have been variously described as 'abrasion', 'erosion', 'abrasion/erosion', and 'idiopathic cervical'. However, many lesions do not fit the classical appearance or location of an erosive and/or abrasive origin, and there is increasing interest in the possible role of occlusal stress in their aetiology. Non-carious cervical lesions often require restoration, and there are essentially three options using tooth-coloured materials: a restorative glass ionomer cement, a liner/base glass ionomer cement overlayed with a resin composite, or a resin composite bonded by an enamel/dentine-adhesive. The materials and techniques used in these options are discussed, indicating their advantages and disadvantages. Results of available clinical trials of these systems are given, and the link with the stress theory of cervical tooth loss is described. The preferred restorative approaches in order are: resin-modified restorative glass ionomer; resin-modified liner/base glass ionomer with a microfine resin composite overlay; enamel/dentine bonding agent with a microfine resin composite.

Adhesives↗

Osseointegrated implants in post-surgical prosthodontic rehabilitation.

The advent of osseointegrated implants and their use in dentistry has been well documented and continues to become more and more a part of conventional dental treatment. Apart from their use in simple situations they can prove invaluable when there is little hope of success with the other options. Two cases are presented here that involve multiple tooth loss as a result of surgical intervention and treatment of pathological lesions.

Adult↗

Traumatic fracture of anterior teeth in 12-year old Nigerian children.

INTRODUCTION: The WHO has chosen the 12year-old age group as one of the sentinel groups for the monitoring of oral health of the population. Tooth loss in 12year olds is significant because the dentition is still developing and any disruption will affect the development of the arch, occlusion and patient's aesthetic. MATERIALS AND METHODS: 1600 12-year-old secondary school pupils were examined in six local government areas of Lagos State. The WHO pathfinder methodology was used. RESULTS: In this study, more boys 86 (10.8%) had various degrees of trauma to their anterior teeth compared to 71 girls (8.9%)(M:F Ratio is 1.2:1). The overall prevalence of tooth fractures was 9.8%. The most frequent injury was class II fractures (52.2%) and there were more fractures to the maxillary teeth than mandibular teeth, the difference is statistically significant p<0.0 1. The central incisors were the teeth most frequently fractured in both sexes. DISCUSSION: The prevalence of fractured anterior teeth in this study, even though is lower than earlier studies can be said to be high for this age group because the greatest number of injuries occur at about 14 years of age. Maxillary incisors in this study have a higher prevalence of fractures. A significant finding in this study is that none of the students with fractured anterior teeth have received dental treatment for the fractures CONCLUSION: There is a high prevalence of fractured anterior teeth in 12year- olds and this problem has not received the necessary attention of the dental profession. Oral health education with the provision of school dental services is recommended as means of solving this problem.

Accidental Falls↗

Biological activities of lipopolysaccharides from oral bacteria and their relevance to the pathogenesis of chronic periodontitis.

Chronic periodontitis is a major cause of tooth loss in adults and is a consequence of the colonisation of the subgingival region by organisms such as Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum. Lipopolysaccharide (LPS) is a constituent of the cell walls of all of these bacteria and is found in large quantities on the surfaces of periodontally-diseased teeth. LPS from oral bacteria has a marked effect on most types of cell found in the periodontal tissues including macrophages, lymphocytes, fibroblasts and osteoblasts. Fibroblasts and macrophages respond to oral LPS by secreting a range of cytokines, and other effector molecules, with inflammatory, immunomodulatory and tissue-destroying capabilities. Lymphocytes are stimulated by LPS to produce a wide range of antibodies with different specificities, hence exacerbating the inflammatory response. By its actions on bone cells, LPS can stimulate bone resorption and inhibit bone formation resulting in erosion of the tooth-supporting alveolar bone. There is, therefore, considerable evidence implicating LPS in the pathogenesis of chronic periodontitis. However, the possible involvement of other biologically-active bacterial components must not be overlooked.

Alveolar Bone Loss↗

Disuse and functional overload induced by tooth extraction alters neuromuscular morphology in C57BL/6J mice.

The effects of functional disuse and overload on the morphology of neuromuscular junctions (NMJ) in masseter muscles of 8 month old C57BL/6J mice were studied. In order to stimulate disuse caused by tooth loss, teeth were extracted from one upper quadrant of 10 mice. The side where teeth were removed was functionally disused (D), since occlusion could not be achieved. Similarly, the intact contralateral (CL) side experienced overload. Morphological measurements were taken of zinc iodide osmium (ZIO)-stained NMJs from control animals, and treated animals at 7 days (7D) and 4 months (4M) post-extraction. Data was analyzed with repeated measures multivariate analysis of covariance (MANCOVA). Test animals did not lose weight, which indicated that sufficient food was consumed after tooth extraction. Fiber diameters from the 7D group were smaller than the controls, while those from the 4M animals were larger. In both the 7D and 4M animals, the CL fibers were larger than the D fibers. There was a trend towards larger NMJs in the 4M animals than in control animals of the same age. NMJs from the CL side of the 4M animals had 14% larger nerve terminal areas (p<0. 1), while on the 4M D side they were 6% larger (p<0.10). NMJs from the 4M D group had 5% longer nerve terminals (p<0.07), while the 4M CL NMJs were 6% longer (p<0.05). NMJs from the D side of the 7D animals were 5% smaller in area while on the CL side they were 11% smaller (p<0.1). Nerve terminals in 7D animals were 6% longer (p<0.05) than in controls. Changes in NMJ morphology following tooth extraction were probably due to differences in degeneration -regeneration of nerve terminals. Acute disuse and overload probably produced greater nerve terminal retraction, whereas chronic changes consisted of a recovery characterized by NMJ plasticity similar to that observed in exercise, disuse and aging studies.

Animals↗

Endodontic treatment of developmental anomalies in posterior teeth: treatment of geminated/fused teeth--report of two cases.

AIM: Gemination or fusion is a rare occurrence in the mandibular posterior teeth. Endodontic treatment of these teeth needs special care and attention to the bizarre anatomy. The aim of this article is to describe the problems encountered and the strategy in treating such cases. CASE REPORT: Two cases of complex endodontic treatment of fused/geminated teeth are presented. The first is an 11-year-old girl with an anomalous 'double' first mandibular molar and premolar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin; the second is a 16-year-old boy with 'double' second and supernumerary mandibular molars, who was diagnosed with irreversible pulpitis. Both cases were treated successfully in multiple appointments. The common features and treatment modalities are discussed. KEY LEARNING POINTS: Failure to diagnose fused/geminated teeth leads to misdiagnosis and a treatment plan that could cause permanent damage and tooth loss. Generally, there is communication between root canal systems of fused/geminated teeth which should be treated as one entity. Use of magnification is an important aid during treatment.

Adolescent↗

Auto-transplantation in the restorative management of traumatized anterior teeth: a case report.

UNLABELLED: Auto-transplantation can be used to replace missing anterior teeth following traumatic injuries. This technique has the advantage (over other forms of treatment) of maintaining alveolar bone height which allows orthodontic and further restorative intervention by way of implants later in life. Careful restorative management of transplanted teeth is vital to their long-term survival as inadequate maintenance post transplant may result in root resorption and eventual tooth loss. This paper describes the restorative management of two cases following transplantation. CLINICAL RELEVANCE: Dental practitioners should be aware of the option to auto-transplant teeth as part of an overall treatment plan and the subsequent interventions often required.

Adolescent↗

Retrospective case series analysis of the factors determining immediate implant placement.

Implant placement at the time of extraction has become an acceptable treatment option. The formation of a restorative treatment plan frequently requires the removal of questionable and hopeless teeth. This retrospective case series analysis reports the reasons for tooth removal before immediate implant placement and provides a rationale for removing questionable and hopeless teeth. Root length is also analyzed as related to tooth loss. Between September 1986 and December 1998, 460 teeth were removed from 282 patients. Reasons for removal were advanced periodontal disease, endodontic complications, nonrestorable caries, roots fractures, short roots (< 14 mm in length), root resorption, and loosened posts. Implants were placed at the time of extraction. Tallies, frequency distributions, and percentages were used to determine individual and multiple reasons for extraction. For teeth with short roots, computerized measurements were made from periapical x-rays. Advanced periodontal disease and restored endodontically treated teeth with posts were the primary reasons for tooth extraction. Dental implants replaced 305 maxillary and 155 mandibular teeth.

Adolescent↗

The erosive susceptibility of cervical versus occlusal enamel.

Clinical studies have strongly suggested a multifactorial aetiology for abfraction lesions or non-carious cervical tooth loss, with a contribution from erosive agents. Structural studies have shown that cervical enamel is more porous with a poorly developed crystal structure that may be more prone to erosion. The aim of this study was to examine the susceptibility to erosion of cervical and occlusal enamel from human premolar and molar teeth. Small blocks of cervical and cuspal enamel were immersed in either orange juice or Coca-Cola and the surface enamel loss was measured using profilometry. The enamel loss was essentially linear at a rate of 2.2-8.8 microns/hr. It was concluded that there was little difference in the susceptibility to erosion between cervical and cuspal enamel, even when the surface hypermineralised layer was removed.

Analysis of Variance↗

Common oral conditions in the elderly.

As the proportion of elderly persons in the population increases, physicians will more frequently see patients with the oral lesions that commonly occur in this group. Periodontal disease represents the most common cause of tooth loss in the elderly. Dentures can create several problems, including traumatic ulceration, denture stomatitis, inflammatory papillary hyperplasia and epulis fissurata. Erythroplakia, rather than leukoplakia, is the most common precursor of oral carcinoma in elderly persons.

Aged↗

Lethal and mild hypophosphatasia in half-sibs.

This report concerns a family showing both the lethal and mild form of hypophosphatasia in half-sibs. In addition, several other paternal family members with the mild form are documented. The lethal form is characterized by extremely low to absent alkaline phosphatase activity in serum with hypomineralization of the skeleton, whereas mildly affected individuals have enzyme levels intermediate between normal and lethal states. On the basis of this pedigree and because the mildly affected individuals have both biochemical abnormalities and the clinical phenotype of premature tooth loss, we prefer to designate hypophosphatasia as a dominant trait affecting both osteogenesis and cementogenesis which has mild clinical expression in the heterozygote but lethality in the homozygote. This situation resembles the dominantly inherited enzymopathy acute intermittent porphyria.

Adult↗

Oral health and dental attendance patterns of Pacific people in Christchurch, New Zealand.

OBJECTIVES: To determine levels of self-reported oral health, dental attendance patterns and barriers to seeking dental care among a Pacific community in New Zealand. DESIGN: Cross-sectional study using a self-completed questionnaire. SETTING: A Pacific Island Health Trust in Christchurch. PARTICIPANTS AND METHODS: Adults affiliated to the Pacific Trust Canterbury, who were in contact with any of the Trust's health services within a four-week period, were invited to complete a dental self-report questionnaire. RESULTS: One hundred and twenty-one Pacific adults took part in the study. The mean age of the sample was 38.7 years, with an age range of 17 to 77 years. Over half the respondents had not attended a dentist within the previous two years, and more than three-quarters had last attended a dentist because of pain. Most respondents had paid for their last treatment themselves, and over half had received an extraction because of infection. Participants who received a Government benefit were more likely to have used a public dental service than those in paid employment. Those who had not received education beyond secondary school were more likely to have used a public dental service than those who had achieved higher education levels. Males were more likely to have had a tooth removed due to infection than females; and Cook Island, Niuean and other Pacific groups were more likely to have had a tooth removed than Samoans. CONCLUSIONS: Most Pacific people among this sample were episodic dental attenders, usually presenting because of pain. Many depended on hospital dental departments, particularly beneficiaries, those with community services cards, and those in low socioeconomic occupations. Tooth loss was a common occurrence among this population. Further information on Pacific people's oral health in New Zealand would be beneficial.

Adolescent↗

Anterior esthetic fixed appliances for the preschooler: considerations and a technique for placement.

One of the pediatric dentist's greatest restorative challenges is the esthetic rehabilitation of a young toddler who has suffered multiple tooth loss subsequent to rampant early childhood caries or extensive dental trauma. An anterior esthetic appliance may be used to replace lost teeth. The most decisive factor for placing an anterior esthetic appliance is parental desire. Other considerations include: space maintenance, masticatory function, speech development, and tongue habits. However, there is no strong evidence that early loss of maxillary incisors will have any significant, long lasting effect on the growth and development of the child. This paper discusses in detail one type of fixed anterior esthetic appliance and the considerations to be made when deciding when and why to place them.

Child, Preschool↗

[Prosthetic measures in the mixed dentition].

Prosthetic measures in the mixed dentition must allow for the actualities of this developmental phase. Traumatic or developmental injuries to enamel and dentine, accidental tooth loss and hypodontia or oligodontia are indications for prosthetic treatment in school children, at which orthodontic aspects should always be considered. The prosthetic approach is characterized by the respect to preventive aspects related to the further biomorphosis of the dentition. With reference to the different phases of mixed dentition, methodical suggestions are given in the form of tables.

Anodontia↗