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PubMed1996

Subsidized dental care improves caries status in male industrial workers.

The association between an employer-provided dental benefit scheme and dental status was studied in male industrial workers in southern Finland in 1994. A total of 325 workers (age 38-65 yrs) with access to subsidized dental care and 174 controls completed a multiple-choice questionnaire followed by clinical examinations. One or more carious teeth was registered in 19% of the subsidized group and 50% of the controls (P < 0.001). For subjects with retained roots the proportions were 2% and 15%, respectively (P < 0.001). Among those with caries the mean number of carious teeth was 2.1 (SD 2.0) in the subsidized group, and 3.2 (SD 3.8) in the control group (P < 0.05). The groups did not differ significantly in numbers of teeth or filled teeth. The probability of having one or more carious teeth was negatively associated with access to subsidized dental care, with a recall or check-up as the reason for the last dental visit, and with having had the last dental visit within the past two years. The results showed that the dental benefit scheme resulted in less untreated caries.

Adult↗
PubMed1998

DMFT, dmft and treatment requirements of schoolchildren in Asturias, Spain.

An epidemiological survey was carried out in 1992 to study the dental health status of schoolchildren aged 6, 9 and 12 in Asturias, Spain. It focused on the caries prevalence, dmtf, DMFT, restoration indices and dental treatment needs of this population. A representative sample of 1839 subjects, randomly selected and proportionally assigned by age group (6, 9 and 12) with the classroom as the sample unit, was examined. Analysis of the data showed that in 6-year-old children the caries prevalence in primary teeth was 45.8%. The mean caries indices were 2.10 dmft and 0.25 DMFT. At 9 years old the prevalence of caries in primary teeth was 62.8% and in the permanent teeth 49.1%. The mean level of caries was 2.38 dmft and 1.50 DMFT. At 12 years old the caries prevalence in permanent teeth was 71% and in first molars 64.2%. The mean caries experienced was 3.30 DMFT. In all groups the D-component constituted the major part of the caries index. The results for girls were higher than for boys in almost all age groups. Surface fillings were the treatment most required in all age groups.

Age Factors↗
PubMed1999

Association of edentulousness with systemic factors in elderly people living at home.

OBJECTIVE: To examine the association of edentulousness with systemic factors: age, gender, tobacco-smoking, alcohol intake, body mass index, functioning in daily living, cortical thickness at the mandibular angle, and systemic diseases: bone-fracture (an indicator for osteoporosis), diabetes, thyroid disease, hyperparathyroidism, asthma, heart failure, hypertension. METHODS: The study population comprised 293 elderly subjects, 124 (42%) edentulous and 169 (58%) dentate. The data from clinical and radiographic examinations and structured interviews were analyzed by multiple logistic regression. RESULTS: When edentulousness in both the mandible and the maxilla was considered, history of bone fracture and tobacco-smoking were significantly related to complete edentulousness with odds ratios (OR) of 2.51 (95% CI: 1.47-4.28) and 2.42 (95% CI: 1.32-4.43) respectively, associations independent of age and gender. A similar association was found for the edentulous mandible. In the elderly subjects with an edentulous maxilla, besides the significant factors of history of bone fracture and tobacco-smoking, asthma was also associated with edentulousness at an odds ratio of 10.81 (95% CI: 1.38-84.66), oldest subjects most often being edentulous (OR: 2.23, 95% CI: 1.13-4.39). Diabetes was not related to edentulousness either in the mandible or in the maxilla. CONCLUSIONS: The finding of associations of history of bone fracture, tobacco-smoking, and asthma with edentulousness emphasizes the association of systemic conditions with edentulousness. Advanced age was related to an edentulous maxilla. The relationship between asthma and total tooth loss in the maxilla might suggest a local oral effect of medications used by asthmatic patients.

Aged↗
PubMed1999

Edentulism among Finnish adults of working age, 1978-1997.

OBJECTIVES: The dental health of Finnish children and young adults has improved considerably during the last 25 years. At the same time, there are still middle-aged or elderly individuals who have lost some or all of their teeth, since extractions were commonly used as a treatment for dental infections during earlier decades. The aim of the present study was to analyze changes of the prevalence of and risk indicators for edentulism among Finnish adults of working age (15-64 years) from 1978 to 1997. METHODS: The National Public Health Institute has, since 1978, conducted annual surveys concerning health behavior among the Finnish adult population. The data were collected through a mailed questionnaire including questions on the number of missing teeth. Sample sizes varied from 5000 to 6000 and the response rates from 70% to 85%. RESULTS: The dental status profile of the Finnish adult population has changed considerably since 1978. The prevalence of edentulism decreased from 14% to 6% during the study years. At the same time, the number of persons with complete dentition increased from 60% to 80%. The decrease in edentulism was obvious in both sexes, but the change was more remarkable among women. In 1997, the difference between the sexes had almost disappeared. The differences between regional and educational groups were still marked in 1997. Belonging to a certain birth cohort appeared to be the major factor affecting the percentage of edentulous subjects. In 1978 risk indicators of total tooth loss included age, gender, length of education, geographical area, urbanization, marital status, and medication for headache. In 1997 risk indicators included age, length of education, geographical area, history of smoking, and perceived status of health. CONCLUSIONS: The number of totally edentulous working-age persons is rapidly decreasing in Finland. Edentulism was strongly associated with birth cohorts and is apparently accumulating in a diminishing group of people. Relevant factors that were strongly associated with edentulousness did not vary considerably between the study years.

Adolescent↗
PubMed2006

Can the development of new dental caries in Danish schoolchildren be predicted from surveillance data in the School Dental Service?

BACKGROUND: Dental screening programmes for Danish children generally target all children, irrespective of their individual caries risk. The standard screening interval is approximately 12 months. A valid systematic screening tool based on routine information sources is however indispensable, if more selective screening strategies should be developed to target the children at highest risk. OBJECTIVE: To estimate the precision with which Danish schoolchildren at high risk for developing dental caries within 1 year can be identified based on information from routine registers. METHODS: Based on data from the Danish National Board of Health's Recording System for the Danish Child Dental Services and from the Central Office of Civil Registration, 3705 schoolchildren aged 7-12 years were followed through 1994-1996. Dental health information as of 1994 and changes 1994-1995 were applied in multiple logistic regressions together with social data as of 1995 to estimate the individual 1-year (1995-1996) risk of developing caries. RESULTS: In 1995, 37.4% of the children had a DMFS index above 0, and during the following year 21.8% of all children developed new caries. The individual child's 1-year caries risk could be estimated relatively accurately at baseline as indicated by the area (76%) under the receiver operating characteristic curve. About 40% of children with an estimated risk of 20% and above developed new caries, whereas 90% of the rest of the children did not do so. CONCLUSION: Based on information from Danish routine registers children at low caries risk may be identified relatively precisely. This may form the basis for the continuous development and targeting of high-risk strategies, in which the screening for caries among children of estimated low risk may be postponed at least 1 year.

Area Under Curve↗
PubMed1994

Dental injuries, temporomandibular disorders, and caries in wrestlers.

The aim of this study was to examine the prevalence of dental injuries, temporomandibular disorders (TMD), and dental caries in a group of champion wrestlers. Twenty-six male wrestlers, with a mean age of 23 yr, and an age-matched control group participated in the study. A questionnaire was used with questions on trauma, frequency of headache, intensity of practicing sports, use of sugar-containing "sports drinks", use of mouth guards, and previous TMD problems. Four bitewing radiographs were taken in all subjects. In addition, three intraoral apical radiographs of maxillary and mandibular frontal regions were taken in the wrestlers. The number of existing teeth, dental caries, amount and type of restorations, and dental injuries were recorded. Examination of the stomatognathic system comprised bilateral palpation of the masseter and temporal muscles and temporomandibular joints, and evaluation of the mandibular movements. None of the subjects had drunk sports drinks or worn mouth protectors regularly. The wrestlers had more frequent and severe dental injuries localized to the frontal region of the maxilla than the controls. No statistical differences were found in the prevalence of caries or TMD between the groups.

Adolescent↗
PubMed1993

Macaca nemestrina: a non-human primate model for studies of periodontal disease.

The non-human primate Macaca nemestrina was evaluated for use as a potential model in periodontal research by study of 16 animals. Using one incisor, premolar, and molar per quadrant, we measured supragingival plaque, severity of gingival inflammation, and pocket depth, and analyzed the subgingival flora. Serum IgG titers and avidities to antigens of Porphyromonas gingivalis (Pg) and Actinobacillus actinomycetemcomitans (Aa) were also assessed. Ten animals were between 13 and 24 years old, and six were between 4 and 5 years old. While mean gingival inflammation scores were significantly higher for older than for younger animals (2.2 vs 1.8, p < 0.05), mean plaque index scores and mean probing depths did not differ significantly. The animals harbored a subgingival microflora considered to be pathogenic for humans including Aa, Pg, Bacteroides forsythus, Prevotella intermedia I and II, Campylobacter recta and Fusobacterium nucleatum. Aa, however, was found only in the younger animals. All of the animals had serum IgG antibodies reactive with antigens of Pg and Aa, and titers for Pg but not for Aa were significantly higher in the older relative to the younger animals (t test p < 0.02). In contrast, antibody avidity did not significantly differ between the two groups. A combined clinical assessment index based on maximum probing depth, gingival index score, and tooth loss was used to assess the overall disease severity. Titers were positively associated with disease severity (Spearman's rank correlation 0.57, p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed2005

Regenerating the periodontium: is there a magic formula?

OBJECTIVE: Left untreated, periodontal disease results in destruction of periodontal tissues including cementum, bone and the periodontal ligament, and subsequently, tooth loss. Increased research efforts focused on understanding periodontal disease at the cellular, molecular and clinical level have resulted in improved modalities for arresting disease progression; however, outcomes of existing procedures are not predictable and often disappointing. Critical to improving the predictability of regenerative therapies is targeting studies toward enhancing our understanding of the cellular and molecular events required to restore periodontal tissues. DESIGN: Toward this goal our laboratory has focused on defining cells, mechanisms and factors regulating development of periodontal tissues, using in vitro and in vivo rodent models. RESULTS AND CONCLUSION: Results from these studies have enabled us to identify attractive candidate factors/cells including: 1) products secreted by epithelial cells that act on mesenchymal cells (amelogenins): we observed that both follicle cells and cementoblasts are responsive to amelogenin-like molecules resulting in changes in the expression of genes associated with cell maturation; 2) morphogens (bone morphogenetic proteins, BMP): we report that follicle cells respond differently to BMPs vs. cementoblasts, depending on dose of and specific BMP used; 3) phosphates: existing data suggest that phosphates act as signaling molecules regulating the expression of genes associated with cementoblast maturation. Knowledge gained from these studies has provided insight as to the cells/factors required for designing improved regenerative therapies.

Amelogenin↗
PubMed2003

Immediately loaded bar-connected implants with an anodized surface inserted in the anterior mandible in a patient treated with diphosphonates for osteoporosis: a case report with a 12-month follow-up.

BACKGROUND: It has been suggested that tooth loss is greater in the osteoporotic patient population. Only a few cases have been reported in the literature about the use of dental implants in patients with osteoporosis. Diphosphonates are stable analogs of pyrophosphate, a physiologic regulator of calcification and bone resorption. Multiple implant failures have been reported in a patient undergoing treatment with diphosphonates. Recently, several clinical and experimental reports have shown that immediate loading of dental implants is possible in selected situations. PURPOSE: The aim of this case report was to present the clinical outcome of immediate loading of implants in a patient undergoing diphosphonate treatment for osteoporosis. MATERIALS AND METHODS: In a 65-year-old patient undergoing diphosphonate treatment for osteoporosis, four implants were inserted in the anterior mandible. The implants were connected with a bar supporting an overdenture and were then loaded the same day. RESULTS: No problems occurred in the postoperative period. At 1-year follow-up, all four of the implants appeared to be clinically osseointegrated, and no mobility was present. Minimal bone resorption was present around all implants. CONCLUSIONS: Our case report points to the fact that, contrary to what has been reported in the literature, it is possible to successfully insert and load immediately after surgery dental implants in a patient undergoing diphosphonate treatment for osteoporosis.

Aged↗
PubMed2003

Mk III: a third generation of the self-tapping Brånemark System implant, including the new Stargrip internal grip design. A 1-year prospective four-center study.

BACKGROUND: Many prospective studies have shown predictable long-term results of the Brånemark System (Nobel Biocare AB, Gothenburg, Sweden) turned-surface implants in totally edentulous, partially edentulous, and single cases. The Mk III self-tapping implant was introduced by Nobel Biocare in 1999 as part of a new implant generation that improved on the Mk II self-tapping implant that had been introduced in 1992. A new implant design should always be evaluated, preferably in prospective multicenter studies. PURPOSE: The aim of the present prospective multicenter study was to evaluate the short-term success rate of the Brånemark Mk III machined- and turned-surface self-tapping implant and to evaluate the clinical handling of the new Stargrip (Nobel Biocare AB) internal grip design. MATERIALS AND METHODS: The open prospective 1-year multicenter study was performed at four clinics. Sixty-four patients (38 females, 26 males) with a mean age of 51 years (range, 16 to 80 years) were included. Seventeen of the patients were totally edentulous, 26 were partially edentulous, and 21 had single-tooth losses. In total, 194 Mk III implants were inserted, 89 in the maxillas and 105 in the mandibles. RESULTS: Fifty-eight patients were observed for 1 year after prosthetic loading. Three of 194 implants were lost, corresponding to a cumulative success rate of 98.4% after 1 year, 100% for maxillary implants and 97.1% for mandibular implants. The implant driver carried the implants reliably in 99.5% of all treated patients. Sixty-two patients received the planned prosthetic reconstruction. All but one prosthetic reconstruction survived after 1 year of loading. The mean marginal bone resorption, analyzed from radiographs of 143 implants, was 1.15 mm (standard deviation [SD], 1.09 mm) from the second-stage surgery to the 1-year follow-up. CONCLUSION: The 1-year success rate of the Mk III implant was high, and the clinical handling of the internal grip design (Stargrip) improved the surgical technique and was well appreciated by both surgeons and assisting staff.

Adolescent↗
PubMed1997

Treatment planning 2000: an esthetically oriented revision of the original implant protocol.

Soft and hard tissue ridge deformities are prevalent in areas of tooth loss and trauma and can compromise esthetic outcomes. Only a full understanding of the severity of the dimensional defects, the reconstructive techniques available, and the functional and esthetic needs of the final implant restoration will allow the design of a treatment approach that will achieve the desired outcome. This article emphasizes the synergistic relation of the osseous, gingival, and restorative triad in treatment planning. In addition, a systematic approach to the enhancement of this triad, in the partially edentulous patient, is outlined as part of a revised protocol for achieving optimal esthetics in implant therapy.

Dental Implantation↗
PubMed1989

Oral soft tissue status in an elderly institutionalized population.

A total of 1,037 oral soft tissue lesions (3.98 lesions per patient) was found in 260 elderly people of American/European and of Asian/African extraction residing in a home for senior citizens in Jerusalem. There was a strong association between wearing of dentures or usage of bare mucosa for masticatory purposes and the presence of specific lesions at typical locations. A significant difference was found between the two ethnic groups with respect both to pattern of tooth loss and utilization of rehabilitative means. The distribution of the oral soft tissue lesions among the participants in the study seemed to be linked to their cultural background.

Aged↗
PubMed1993

The prevalence of root surface caries amongst Irish adults.

In a national survey of adult dental health conducted in the Republic of Ireland in 1989/90 a total of 1,527 subjects aged 25 and older were examined for root surface caries. It was found that the prevalence of root surface caries was highest in older age groups and also amongst males, residents of non-fluoridated communities and those earning low incomes. Tooth loss masked the potential prevalence of root surface caries. With more persons retaining their natural teeth into middle and old age the prevalence of root surface caries is likely to increase in the future.

Adolescent↗
PubMed2004

Oral mucosal and osseous disorders in frail elders.

OBJECTIVE: This paper reviews the implications of frailty for oral health in old age due to the incidence of oral pathoses following on mucosal atrophy, tooth loss, trauma from dentures, polypharmacy, malnutrition, salivary disorders, degeneration of jawbone and cancer. BACKGROUND: Frailty as a condition of old age occurs when elders have energy levels below a critical threshold, or when the social or cultural environment is limited. RESULTS: Frail elders are particularly vulnerable to pathoses, but not simply because of old age per se. Oral diseases accompanying frailty are due to a complicated mixture of biopsychosocial changes that accompany old age. CONCLUSIONS: Management of oral mucosal and osseous disorders in frail elders requires an understanding of the changes that occur with advancing age.

Aged↗
PubMed1997

Respiratory burst of neutrophils in diabetic patients with periodontal disease.

Periodontal disease, a frequent complication of diabetes mellitus, is the major cause of tooth loss. However, studies on neutrophil function in patients with this condition have yielded contradictory findings. The NADPH oxidase activity of 40 diabetic patients with periodontosis who were on metabolic control was evaluated and compared with that in 40 healthy subjects. Superoxide anion production was measured by a photometric method, with NBT reduction at 490 nm in a microplate reader and by a microscopic method, with a percentage of positive PMNs with granules of formazan in the cytoplasm. When the PMN respiratory burst was activated by phorbol myristate acetate (PMA), a protein kinase C (PKC) soluble activator, superoxide production of diabetics (4.31 +/- 1.67 A x 10(-3)/min) and normal subjects (4.25 +/- 1.25 A x 10(-3)/min) was comparable by photometric method, whereas a significantly defective response to opsonized zymosan was observed when the microscopic method was used (58 +/- 17% in diabetics and 66 +/- 18% in controls; p = 0.05). Therefore in patients with diabetes the impact on PMN function is of multifactorial origin, and is probably correlated to the glucose level and to glycation of PMN protein, such as NADPH oxidase or myeloperoxidase. Alternatively, glucose in PMN may be reduced by aldose reductase to polyols, and this pathway requires NADPH, the coenzyme for the respiratory burst. Moreover, we found that superoxide production in response to opsonized zymosan was reduced in diabetic patients. The activation of protein tyrosine kinase (PTK) is an important mechanism underlying transmembrane signaling and, moreover, protein tyrosine phosphorylations, stimulated by zymosan receptor-mediated activation, might be caused by the activation of specific PTK, whereas activation by PMA is probably mediated through another PKC type.

Chemotaxis, Leukocyte↗
PubMed1985

Methodological considerations in a dental epidemiologic survey of an elderly population.

The proportion of the US population that is age 65 or over is increasing and edentulism rates are declining. The community's elderly population is becoming an increasingly important constituency for dental public health. Little is known, however, about the actual oral health status of these people. An assessment of oral health in the elderly presents many considerations not found in an assessment of oral health among children. The selection of subjects to represent all the elderly in the community is difficult. Caries assessment is complicated by the need to distinguish between coronal caries and root caries and by the inability to determine accurately the reason for prior tooth loss. Periodontal assessment is more difficult than in younger populations because the conditions tend to be advanced. The recruitment of participants is difficult because each potential subject must be contacted individually. These assessments are needed so the oral status of adult populations can be determined.

Aged↗
PubMed1990

Oral health status of a federal prison population.

The purpose of this study was to describe the prevalence of decayed, missing, and filled teeth among federal male prisoners (aged 21-75) in the US Penitentiary. Leavenworth, Kansas, and to assess the impact of age, race, number of years incarcerated, and number of visits to the prison dentist on these parameters of oral health. Inmates (n = 191) were randomly selected and represented 16.4 percent of the prison population (N = 1,161). Two calibrated examiners collected caries and tooth loss data using NIDR criteria. No radiographs were taken. Results showed a mean DMFT of 12.9 for inmates aged 20-34, 16.4 for inmates aged 35- 44, and 22.1 for inmates aged 45 and older. Whites had significantly fewer decayed teeth (P less than .05) than black inmates for ages 20-34. The number of missing teeth increased significantly (P less than .01) with inmate age. Proportion edentulous (both arches) was 5.2 percent for ages 35 to 44, 17.3 percent for ages 45-54, and 45.5 percent for ages 55 to 75. Cross tabulations and chi-square analyses showed that inmates incarcerated less than two years had a significantly (P less than .001) lower utilization rate of dental services, and that inmates who made greater use of available dental services had fewer decayed teeth than those with lower utilization rates.

Adult↗