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Factors affecting postmortem tooth loss.

Unassociated human bones are a particular problem during the exhumation of mass graves and a factor that limits anthropological and paleopathological analyses from archaeological contexts. Extensive anthropological literature has focused on the complex taphonomic factors that influences bone assemblages, but little attention has been paid to postmortem tooth loss and factors affecting this process. The following study focuses upon the influence of different factors on postmortem tooth loss. Three samples were investigated in the study: a medieval church cemetery containing 110 individual skeletal remains, and two samples from a series of mass graves made within the same time period in 1999, containing 402 bodies. The frequency of postmortem tooth loss was analyzed relative to postmortem interval for each sample, excavation methods, age distribution, and presence of bone loss associated with periodontal disease. Our results indicate that the degree of alveolar bone loss significantly affected both antemortem and postmortem tooth loss and that the frequency of postmortem tooth loss has the strongest correlation to time since death. These findings suggest that additional care should be taken when exhuming remains from older contexts.

Adolescent↗

Salivary flow and risk of tooth loss in an elderly population.

To investigate the relationship between salivary flow and tooth loss, 818 randomly selected dentate people aged 65 and older and living in North Carolina were administered a dental health interview and examination. A single paraffin-stimulated whole saliva sample of 3 ml was collected and flow rate was calculated. Three years later, 490 people were re-examined and tooth loss was determined. Thirty-five percent of the participants had salivary flow rates of 1.0 ml/min or less at baseline and 41% lost at least one tooth over the 3-yr follow-up. A logistic regression model controlling for marital status, race, and socioeconomic status showed that those with low salivary flow were more likely to lose at least one tooth during the 3-yr study period than were those with normal flow (odds ratio = 1.52, 95% CI = 1.02-2.24). Results from this representative study of community-dwelling older adults support the concept that compromised salivary flow is related to tooth loss. This finding should be considered in the management and prevention of oral diseases.

Age Factors↗

A preliminary investigation of postmortem tooth loss.

Forensic anthropologists have found a seemingly increased frequency of dismemberment cases and subsequent scattering of the elements that mandates developing unconventional methods of estimating postmortem interval. The chronological sequence in postmortem tooth loss has been investigated as an indicator for estimation of time since death. The anterior dentitions of cadavera were observed to discern patterns in "drop time" based on age, periodontal health, seasonality and location of body placement. Individuals deposited in the summer months lost teeth much more rapidly than those deposited in the late fall or winter months. Similarly, individuals exposed to direct sunlight, a micro-environment where rapid decomposition has been noted, lost teeth before individuals in shaded locales. Since tooth loss is dependent on the deterioration of the soft tissues which bind the tooth into the alveolar bone, we found tooth loss to be correlated with general soft tissue decomposition rates as dictated by season and environment. When utilized as sole indicator, the patterns of postmortem tooth loss can not be used for estimating time since death. However, when used in conjunction with other indicators, tooth loss patterns may provide useful information for more accurate estimation of the postmortem interval.

Adult↗

Incidence and predictors of self-reported tooth loss in a representative sample of Norwegian adults.

OBJECTIVES: The purpose of this study was to determine the self-reported 12-month incidence of tooth loss among Norwegian adults and to assess the association between tooth loss and some predictor variables. METHODS: Of a two-stage nation-wide, representative random sample (n = 3958), information was obtained from 2682 subjects aged 20-79 years and the response rate was 68%. Telephone or face-to-face interviews by interviewers employed by the Central Bureau of Statistics (CBS) of Norway. Information was collected about demographic characteristics, the number of natural teeth present, the number of teeth lost during the last 12 months, and belief in keeping natural teeth for life. The present analyses are based on 2520 persons 20-79 years of age. RESULTS: The proportion of respondents who reported losing one or more teeth was 6.45% (95% confidence limits (CL) = 5.49, 7.41). The participants who reported extractions had lost on average 1.54 (range 1-9) teeth. Multiple logistic regression analysis revealed a borderline significant effect of the level of education (OR = 0.68, 95% CL = 0.46, 1.00), i.e. the odds of losing one or more teeth during the last 12 months were lower among persons with more than 12 years of education than among persons with less education. The explained variance was 1.9%. CONCLUSION: The annual incidence rate of tooth loss among Norwegian adults was found to lie within the range reported from other industrialized countries. After controlling for socio-demographic variables and the number of teeth present, the only borderline significant predictor of the incidence of tooth loss was the level of education.

Adult↗

Tooth loss and skeletal bone density in healthy postmenopausal women.

Associations between dental status and skeletal bone density were investigated in a group of 329 healthy postmenopausal women with normal bone density. Bone mineral density (BMD) of the lumbar spine, femoral neck and distal radius were measured by dual- or single-photon absorptiometry. Number of teeth remaining were counted and presence of complete dentures noted by a nurse practitioner. Forty-eight women (15%) wore a complete maxillary and/or mandibular denture: 22(7%) were completely edentulous and an additional 26 (8%) had one edentulous ridge. Among women without complete dentures (n = 281), significant positive linear relationships were observed between number of teeth and BMD at the spine (p < 0.05) and radius (p < 0.01), controlling for years since menopause, pack-years of smoking, education and body mass index. BMD did not differ between the groups with and without dentures. However, women who acquired dentures after the age of 40 years had significantly lower mean spinal and radial BMD than women who acquired dentures at age 40 years or earlier (at the radius, 0.584 +/- 0.015 v 0.630 +/- 0.017 g/cm2, p < 0.05; at the spine, 1.043 +/- 0.031 v 1.124 +/- 0.029 g/cm2, p = 0.05). In linear regression analysis, significant independent correlations were found among all women (n = 329) between number of teeth and age (partial r = -0.19, p < 0.001), pack-years of cigarette use (partial r = -0.23, p < 0.001) and years of education (partial r = +0.11, p < 0.05). These associations between dental status and BMD support the hypothesis that systemic bone loss may contribute to tooth loss.

Adult↗

Sentiments expressed in relation to tooth loss: a qualitative study among edentulous Saudis.

PURPOSE: The objective was to explore and gain insight into the sentiments surrounding tooth loss in a group of edentulous Saudis. MATERIALS AND METHODS: Using a qualitative methodology, 44 edentulous patients who were receiving complete denture treatment were interviewed in private, in the Arabic language. Interviews were tape recorded and semistructured, following a list of predetermined and piloted topics, but dialogue also took place, with the freedom for both interviewer and interviewee to explore areas of interest. All recordings were transcribed, translated into English, and interpreted independently by two members of the team to identify the core themes associated with tooth loss. RESULTS: The mean age of participants was 58.9 years (range 35 to 72 years), and they had been edentulous for a mean of 7.1 years (range 3 months to 22 years). The main themes related to tooth loss were unqualified acceptance, inevitability with old age, behavior changes with respect to eating comfort, aged appearance, self-responsibility, positively perceived benefits, high prosthetic expectations and reduced level of denture satisfaction, and some need for privacy. CONCLUSION: The lack of any outward indication that participants experienced bereavement suggests that outlook on life can influence the impact of tooth loss. Participants' unqualified acceptance of their edentulous fate, yet their clear need to "normalize" oral function, reflects a degree of pragmatism toward life events. The strong influence of religion in Saudi society is a possible factor in the sentiments expressed.

Adult↗

The effectiveness of periodontal treatment as measured by tooth loss.

In a retrospective study, the authors evaluated the effectiveness of periodontal treatment in preventing tooth loss in patients with moderate to advanced periodontitis. Patients had received maintenance therapy for an average of 12.5 years. Of the 2,899 teeth present after active treatment, 152 were lost to periodontal disease and 68 were lost to other causes during maintenance therapy. The authors evaluated causes and patterns of tooth loss after surgical vs. nonsurgical treatment. Surgery did not significantly improve tooth retention in the high-risk patients. This study and other retrospective studies suggest that tooth loss may be related more to the type of periodontal disease present than to the treatment rendered.

Adult↗

Attitudinal and behavioral characteristics of older Floridians with tooth loss.

In this cross-sectional study of Floridians aged 65 yr or older, 600 persons were interviewed to identify the characteristics of individuals who survived into old age with an intact or nearly intact dentition. Persons with total or partial tooth loss reported less frequent dental care, less ability to pay dental care fees, less frequent dental hygiene, and were more likely to have been smokers or diabetic. Persons with tooth loss also had less positive attitudes toward dentists and dental care. These cross-sectional findings are consistent with tooth loss being the result of disease-, behavior-, and attitude-related causes, and/or their interactions. Tobacco use, diabetes, and infrequent oral hygiene and dental care may increase risk for dental disease; decreased ability to pay for dental treatment may impair utilization of non-extraction treatment options, and negative attitudes toward dental treatment may influence the desire for non-extraction treatment options. Research targeted toward modifying attitudes toward dental treatment may be useful in preventing or delaying tooth loss, and measurement of attitudes may be a useful way to identify individuals at the greatest risk for tooth loss for intervention studies.

Aged↗

Incidence of tooth loss among elderly Iowans.

This study investigated the 18-month incidence of tooth loss in a random sample of 451 dentate noninstitutionalized Iowans aged 65 and older residing in two rural counties. They had a mean of 19.0 teeth at baseline and lost an average of 0.4 teeth during the subsequent 18 months. Twenty-one per cent of the population lost at least one tooth. Four people had all their teeth extracted. Of the teeth present at baseline, 1.9 per cent subsequently were extracted. The highest incidence of tooth loss occurred among mandibular molars (3.7 per cent), followed by maxillary premolars and canines (3.1 per cent each). The best predictors of tooth loss were previous coronal and root caries.

Aged↗

Severe wear and tooth loss in wild ring-tailed lemurs (Lemur catta): a function of feeding ecology, dental structure, and individual life history.

The ring-tailed lemurs at Beza Mahafaly Special Reserve, Madagascar, exhibit a high frequency of severe wear and antemortem tooth loss. As part of a long-term study, we collected dental data on 83 living adult ring-tailed lemurs during 2003 and 2004. Among these individuals, 192 teeth were scored as absent. The most frequently missing tooth position is M1 (24%). As M1 is the first tooth to erupt, its high frequency of absence (primarily a result of wear) is not remarkable. However, the remaining pattern of tooth loss does not correlate with the sequence of eruption. We suggest that this pattern is a function of 1) feeding ecology, as hard, tough tamarind fruit is a key fallback food of ring-tailed lemurs living in gallery forests; 2) food processing, as tamarind fruit is primarily processed in the P3-M1 region of the mouth; and 3) tooth structure, as ring-tailed lemurs possess thin dental enamel. The incongruity between thin enamel and use of a hard, tough fallback food suggests that ring-tailed lemurs living in riverine gallery forests may rely on resources not used in the past. When comparing dental health in the same individuals (n=50) between 2003 and 2004, we found that individual tooth loss can show a rapid increase over the span of one year, increasing by as much as 20%. Despite this rapid loss, individuals are able to survive, sometimes benefiting from unintentional assistance from conspecifics, from which partially processed tamarind fruit is obtained. Although less frequent in this population, these longitudinal data also illustrate that ring-tailed lemurs lose teeth due to damage and disease, similar to other nonhuman primates. The relationship between tooth loss, feeding ecology, dental structure, and individual life history in this population has implications for interpreting behavior based on tooth loss in the hominid fossil record.

Age Factors↗

Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis.

BACKGROUND AND PURPOSE: Males carry a disproportionate burden of cardiovascular disease. Because males also bear a higher burden of periodontal disease, we investigated the existence of gender differences in the postulated relationship between periodontal infections, tooth loss, and subclinical atherosclerosis. METHODS: A total of 1710 randomly enrolled participants between the ages of 45 and 75 with no history of myocardial infarction or stroke received a clinical periodontal examination, carotid scan using high-resolution B-mode ultrasound, and extensive measurements for conventional cardiovascular risk factors (age, education, smoking, alcohol, body mass index, diabetes, systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides) as well as markers of healthy lifestyle and social network. RESULTS: In both genders, measures of current and long-term periodontitis worsened as tooth loss increased. In males but not females, an approximately 10% difference in carotid artery plaque prevalence was observed between the lowest and highest tertiles of tooth loss (P<0.05) and long-term periodontitis (P=0.05) after multivariate adjustment. Similar patterns were observed for intima-media thickness. The influence of gender on carotid artery plaque prevalence was most evident among the younger age group (<59 years). Between genders, carotid plaque prevalence differed by 10%, 15%, and 25% across increasing levels of tooth loss, and by 5%, 15%, and 25% across increasing levels of long-term periodontitis. CONCLUSIONS: Our data suggest that tooth loss and long-term periodontitis are related to subclinical atherosclerosis in men but not women. Gender variations in cardiovascular morbidity or mortality may be explained partly by the differential contributions of novel risk factors across genders.

Aged↗

Tooth loss in a sub-urban Nigerian population: causes and pattern of mortality revisited.

AIM: To determine the current causes and pattern of tooth loss in Ile-Ife Nigeria. DESIGN: A retrospective review of records of dental extraction patients. SETTING: The dental hospitals of the Obafemi Awolowo University Teaching Hospital situated in South Western Nigeria. PARTICIPANTS: All patients that had dental extractions between January 1996 and December 2002. METHOD: Patients' case records were analysed for demographics, reason(s) for dental extraction, tooth/teeth extracted, method of extraction and complication(s). MAIN OUTCOME MEASURE: Reasons for tooth extraction and the pattern of tooth loss. RESULTS: 6348 (12.3%) of hospital attendees aged 4-102 years (mean 35 +/- 16.8 years) had extraction of 8338 teeth. A statistically significant female preponderance was observed. Dental caries was the leading cause of tooth loss (56.4%) followed by periodontal disease (24.6%). This shows a reversal of a trend reported in a previous study in the same location. Over half (69.2%) of the extracted teeth were molars (mostly mandibular). Only 4.1% extractions were trans alveolar. 3.9% were complicated by dry socket. CONCLUSION: 12.3% of the hospital attendees had undergone dental extraction. Despite previous warnings of a steady rise in dental caries, it has become the leading cause of tooth loss in our hospital. The urgent need to institute standardised preventive measures was highlighted.

Adolescent↗

[Diabetes as a risk factor for tooth loss in the geriatric population].

OBJECTIVE: A comparative study of the level and type of tooth loss, and the use of dental prostheses, was performed on one diabetic sample and another non-diabetic one, taken from elderly people receiving health care at the San Pablo Health Centre, Sevilla, in order to assess the repercussion of diabetes on tooth loss. DESIGN: A descriptive and observational study of a crossover type. SETTING: Primary care. San Pablo Health Centre, Sevilla. PATIENTS AND OTHER PARTICIPANTS: Patients aged > 65 requesting health care for any reason at our PC clinic during March-April 1995. MEASUREMENTS AND MAIN RESULTS: 98 patients, 42 diabetics and 56 non-diabetics, were studied. The percentage of toothlessness was significantly greater in diabetic patients than in non-diabetic ones. None of the patients had kept all their teeth. 52.4% of the diabetic patients wore complete prostheses, percentage which went down to 25% in non-diabetics. 57.1% of diabetics and 44.6% of non-diabetics wore some type of prosthesis. CONCLUSIONS: We can consider diabetes as a risk factor in tooth loss among the elderly. Applying buco-dental hygiene measures from the diagnosis of diabetes, along with regular dental check-ups, might significantly lessen diabetics' dental loss over their lives. Opening the elderly person's mouth, whether he/she is diabetic or not, and evaluating oral mucus and dental structure, should be a investigative procedure in primary care.

Aged↗

Tooth loss is independently associated with the risk of acquired aortic valve sclerosis.

BACKGROUND: Several studies have shown that periodontal disease and atherosclerosis are associated. Aortic valve sclerosis (AVS) represents the sum of processes that are similar to the development of atherosclerosis. The present analysis was performed to investigate associations between periodontal disease, tooth loss, and AVS. METHODS: The population-based SHIP was conducted in northeast Germany. A study population of 2341 individuals aged > or =45 years was available for the present analysis. Aortic valve sclerosis was determined by echocardiography. Periodontal status was assessed by attachment loss and tooth loss. RESULTS: The prevalence of AVS was 29.9%. Logistic regression analyses did not reveal attachment loss as an independent risk factor for AVS. However, a reduced number of teeth was independently associated with AVS. Other risk factors for AVS were age, history of myocardial infarction, body mass index, pulse pressure, plasma fibrinogen and lipoprotein (a) levels, and the use of drugs that act on the renin-angiotensin system. CONCLUSION: A reduced number of teeth was independently associated with the risk of AVS. This finding further strengthens the link between oral health and cardiovascular disorders.

Adult↗

Tooth loss and heart disease: findings from the Behavioral Risk Factor Surveillance System.

BACKGROUND: The purpose of this study was to examine the association between tooth loss and heart disease. METHODS: Data were analyzed from the 1999 to 2002 Behavioral Risk Factor Surveillance System, an ongoing telephone survey operated by state health agencies with assistance from the Centers for Disease Control and Prevention. The study was conducted based on 41,891 adults aged 40 to 79 years old in 22 states and the District of Columbia. RESULTS: A significant association was observed between the extent of tooth loss and heart disease prevalence. After adjustment for age, gender, race/ethnicity, education, and marital status, respondents who had 1 to 5 missing teeth, 6 to 31 missing teeth, or were edentulous were significantly more likely than those without tooth loss to have heart disease (adjusted prevalence: 6.8%, 10.2%, and 11.5%, respectively, vs. 5.3%; p<0.001). These associations persisted after further adjustment for smoking status, diabetes, alcohol consumption, hypertension, hypercholesterolemia, and body mass index (5.7%, 7.5%, and 8.5%, respectively, vs. 4.7%; p<0.05); and after stratification by age group (40 to 59 years and 60 to 79 years) and smoking status (ever smoked and never smoked). CONCLUSIONS: Tooth loss is associated in a consistent and graded fashion with the self-reported prevalence of heart disease. Health promotion counseling should include the prevention and control of cardiovascular disease risk factors and the maintenance of good oral health.

Adult↗

Tooth loss during maintenance following periodontal treatment in a periodontal practice in Norway.

BACKGROUND: Periodontal therapy coupled with careful maintenance has been shown to be effective in maintaining periodontal health; however, a small number of teeth are still lost because of progressive periodontitis. AIM: To investigate factors associated with tooth loss due to periodontal reasons during maintenance following periodontal treatment in patients in a Norwegian specialist periodontal practice. The study also examined how initial prognosis related to actual outcome as measured by periodontal tooth loss. METHODS: Hundred consecutive patients (68 females, 32 males) who had comprehensive periodontal treatment and attended for 9.8 (SD: 0.7), range: 9-11 years of maintenance care, were studied. All teeth classified as being lost due to periodontal disease over the period were identified. RESULTS: Only 36 (1.5%) of the 2436 teeth present at baseline were subsequently lost due to periodontal disease. There were 26 patients who lost at least one tooth. Logistic regression analysis showed that tooth loss was significantly related to male gender (p=0.049; adjusted odds ratio: 2.8; confidence interval (c.i.): 1.0-8.1), older age, i.e.>60 years (p=0.012; adjusted odds ratio: 4.0; c.i.: 1.3-12.0) and smoking (p=0.019; adjusted odds ratio: 4.2; c.i.: 1.4-13.8). The majority 27 (75%) of the teeth lost due to periodontal disease had been assigned an uncertain, poor or hopeless initial prognosis; however, nine teeth (25%) lost had been assigned a good prognosis at baseline. The prognosis for 202 teeth was judged to have worsened over the period of the study. CONCLUSION: Compliance with maintenance following periodontal treatment was associated with very low levels of tooth loss in a referral practice in rural Norway. Male gender, older age (>60 years) and smoking were predictors of tooth loss due to progressive periodontitis.

Adult↗

Tooth loss occurring at a place other than a health-care facility: 72-month incidence.

Dental care can occur within or outside the formal health-care system. We hypothesized that certain subject characteristics would partly explain one type of dental self-care, non-professional extractions. A representative sample of diverse groups of dentate adults was studied. In-person interviews and clinical examinations were conducted at baseline, 24, 48, and 72 months, with semi-annual telephone interviews in between. Of 699 participants, 291 (42%) reported loss of at least one tooth, of whom 42 (14% of those with tooth loss) reported having lost the tooth at a place other than a health-care facility. Ninety-four percent of non-professionally lost teeth were self-extracted; relatives extracted the remainder. Fifty-eight percent of these teeth were deliberately removed; the remainder came out while subjects were eating or brushing their teeth, or due to injury. Attachment loss and mobility at previous examination were consistent with the occurrence of non-professional extraction. The incidence magnitude was substantive and persistent throughout follow-up.

Aged↗

Abutment tooth loss in patients with overdentures.

BACKGROUND: Since the 1960s, the use of natural teeth as overdenture abutments has become part of accepted clinical practice. Several longitudinal studies have been conducted, but tooth loss has not been reported to be a significant problem. The aim of this study was to identify the incidence and causes of tooth loss in a prospective cohort study of subjects wearing overdentures. METHODS: The study, conducted between 1973 and 1994, evaluated 273 subjects (62.3 percent male) with a mean age of 59.6 years. RESULTS: Of the 273 subjects with 666 abutments, 74 lost 133 abutments. The most common cause of tooth loss was periodontal disease (29.3 percent) followed by periapical lesions (18.8 percent) and caries (16.5 percent). Through logistic regression, the authors found that subjects who lost teeth were more likely to have medical problems that could cause soft-tissue lesions of the oral mucosa, were less likely to use fluoride daily and were less likely to return for yearly recall visits. The authors found 22 vertical fractures in 17 subjects. Chi2 analysis revealed that overdenture teeth in the maxillary arch that were opposed by natural teeth were more likely to experience vertical fractures. CONCLUSIONS: In a study that followed up some patients for as long as 22 years, the rate of tooth loss was 20.0 percent. Many of these failures could have been prevented if patients had practiced better oral hygiene. CLINICAL IMPLICATIONS: The findings suggest that if a dentist recommends overdenture therapy, the patient needs to be examined regularly to reduce the risk of experiencing caries and periodontal disease. Also, if the abutments are in the maxilla and are opposed by natural teeth, the dentist should consider using thimble crowns to reduce the risk of vertical fractures.

Aged↗