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PubMed2003

Vitamin D receptor alleles, periodontal disease progression, and tooth loss in the VA dental longitudinal study.

BACKGROUND: The relationship between the vitamin D receptor (VDR) genotype and periodontal disease is not known. This study compared periodontal disease progression among polymorphisms of 2 VDR genes in men in the VA Dental Longitudinal Study. METHODS: Subjects were 125 medically healthy, middle-aged men who had serial oral examinations over a mean 23-year period. Probing depth, gingival bleeding on probing, clinical attachment loss (CAL), and alveolar bone loss (ABL) from radiographs were measured at each examination. Progression of periodontal disease was defined as the percentage of teeth per decade that increased ABL by > or = 40%, and the percentage of teeth per decade that developed CAL > or = 5 mm. ApaI and TaqI polymorphisms were determined from buffy coat cells following polymerase chain reaction (PCR) amplification. Mean changes in oral status were adjusted for baseline values of smoking status, number of teeth present, and periodontal status by analysis of covariance. RESULTS: Genotype distributions were 41 AA, 58 Aa, 26 aa; and 53 TT, 46 Tt, 26 tt. The AA genotype showed the highest rates of progression of ABL (5 +/- 1% versus 1 +/- 1% and 2 +/- 1% teeth in Aa and aa, respectively; P = 0.03), CAL (37 +/- 4% versus 17 +/- 4% and 27 +/- 6% teeth; P = 0.004), and tooth loss (2 +/- 0.3 versus 1 +/- 0.3 and 1 +/- 0.4 teeth; P = 0.04). When genotype combinations were examined, progression of ABL, CAL, and tooth loss was highest in the AATT and AATt genotypes. CONCLUSIONS: The ApaI polymorphism of the VDR gene is associated with oral bone loss, clinical attachment loss, and tooth loss in older men. Analysis of the VDR alleles may prove useful for predicting periodontal disease.

Adult↗
PubMed1982

Tooth loss in 100 treated patients with periodontal disease. A long-term study.

A population of 100 patients with periodontal disease who had been treated and maintained for 15 years or longer was studied for tooth loss. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. Patients were examined and their dental records were reviewed. On the basis of response to therapy and tooth loss, the patients were classified as Well-Maintained (77), Downhill (15), or Extreme Downhill (8). At the completion of initial treatment, 2,627 teeth were present. Of this number, during the maintenance period, 259 teeth (9.8%) were lost due to periodontal disease, while 40 teeth (1.5%) were lost due to other causes. Evaluation was made as to patterns of tooth loss, loss of questionable teeth, loss of teeth with furcations, surgical vs. nonsurgical therapy, and presence of fixed or removable prostheses. Considerable variation occurred between response groups. Periodontal disease appears to be bilaterally symmetrical and tooth loss response emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids.

Adolescent↗
PubMed2004

Birth order, sibship size, and housing density in relation to tooth loss and periodontal disease: a cohort study among Swedish twins.

For diseases with an infectious etiology, birth order may dictate the age of exposure to childhood infection, while sibship size may be a proxy for the probability of exposure. The authors examined whether birth order, sibship size, and childhood housing density affect risk of tooth loss and periodontal disease. The study included 28,690 adults aged > or = 42 years who were participating in a 1998-2002 follow-up of persons listed in the Swedish Twin Registry. Logistic regression was used to calculate odds ratios and 95% confidence intervals, with adjustment for age, sex, education, and smoking and mutual adjustment for family composition (sibship size and/or birth order). Tooth loss and periodontal disease affected 8% and 19% of the twins, respectively. Each additional sibling increased the odds of tooth loss by 10% (95% confidence interval (CI): 1.06, 1.15) and the odds of periodontal disease by 5% (95% CI: 1.02, 1.08). Later birth order was associated with lower odds of periodontal disease. Each additional person per room in the childhood home increased the odds of tooth loss (odds ratio = 1.28, 95% CI: 1.03, 1.60) but lowered the odds of periodontal disease (odds ratio = 0.65, 95% CI: 0.48, 0.89). These findings are compatible with the hypotheses that adult oral diseases are associated with the probability of exposure in childhood and that earlier age at exposure lowers risk.

Adult↗
PubMedDate not supplied

Association of estrogen and vitamin D receptor gene polymorphisms with tooth loss and oral bone loss in Japanese postmenopausal women.

OBJECTIVE: To investigate the relationship between estrogen receptor (ER) and vitamin D receptor (VDR) gene polymorphisms and tooth loss, oral bone loss, and postcranial bone mineral density (BMD) in Japanese postmenopausal women. DESIGN: Polymorphisms at the ER PvuII and XbaI and VDR BsmI gene sites, number of teeth remaining, oral bone mass, and BMD of the lumbar spine and the hip were evaluated in 149 Japanese postmenopausal women. RESULTS: The distribution of ER PvuII and XbaI and VDR BsmI restriction fragment length polymorphisms was as follows: pp, 30.2%; Pp, 49.7%; PP, 20.1%; xx, 71.8%; Xx, 22.5%; XX, 2.7%; bb, 76.5%; Bb, 22.2%; and BB, 1.3%. Analysis of covariance adjusted for confounding variables revealed that participants with pp allele had fewer teeth remaining than did those with P allele. There were no significant differences in oral bone mass and postcranial BMD among three alleles at the PvuII site. Participants with X and bb allele had less oral bone mass and lower postcranial BMD than did those with xx and B allele, respectively. We could not clarify the positive associations between XbaI and BsmI polymorphism and number of teeth. CONCLUSIONS: PvuII polymorphism was associated with tooth loss, but not with oral bone mass and postcranial BMD. XbaI and BsmI polymorphisms may be associated with bone mass or density; however, PvuII polymorphism might contribute to another unknown pathway related to tooth loss.

Adult↗
PubMed2005

Risk indicators for tooth loss due to periodontal disease.

BACKGROUND: Several risk indicators for periodontal disease severity have been identified. The association of these factors with tooth loss for periodontal reasons was investigated in this cross-sectional comparative study. METHODS: All extractions performed in 21 general dental practice clinics (25% of such clinics in Kuwait) over a 30-day period were recorded. Documented information included patient age and gender, medical history findings, dental maintenance history, toothbrushing frequency, types and numbers of extracted teeth, and the reason for the extraction. Reasons were divided into periodontal disease versus other reasons in univariate and binary logistic regression analyses. RESULTS: A total of 1,775 patients had 3,694 teeth extracted. More teeth per patient were lost due to periodontal disease than for other reasons (2.8 +/- 0.2 versus 1.8 +/- 0.1; P <0.001). Factors significantly associated with tooth loss due to periodontal reasons in logistic regression analysis were age >35 years (odds ratio [OR] 3.45; 95% confidence interval [CI] 2.79 to 4.26), male gender (OR 1.42; 95% CI 1.17 to 1.73), never having periodontal maintenance (OR 1.48; 95% CI 1.23 to 1.78), never using a toothbrush (OR 1.81; 95% CI 1.49 to 2.20), current or past smoking (OR 1.56; 95% CI 1.28 to 1.91), anterior tooth type (OR 3.23; 95% CI 2.57 to 4.05), and the presence of either of the following medical conditions: diabetes mellitus (OR 2.64; 95% CI 2.19 to 3.18), hypertension (OR 1.73; 95% CI 1.41 to 2.13), or rheumatoid arthritis (OR 4.19; 95% CI 2.17 to 8.11). CONCLUSION: Tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis, and anterior tooth type.

Adolescent↗
PubMed2004

Tooth loss is associated with an increased risk of hypertension in postmenopausal women.

Tooth loss has been associated with an increased risk of vascular diseases such as coronary heart disease and cerebrovascular disease. Little is known whether hypertension is an important factor linking 2 phenomena in postmenopausal women. We compared an incidence of hypertension and traditional risk factors for vascular diseases between 2 age-matched groups: 67 postmenopausal women with missing teeth and 31 without missing teeth. In addition to blood pressure, serum concentration of total cholesterol, high- and low-density lipoprotein cholesterol and triglycerides, plasma angiotensin-converting enzyme activity, plasma angiotensin II concentration, plasma renin activity, and resting heart rate were measured as traditional risk factors for vascular diseases. Subjects without missing teeth had significantly lower diastolic blood pressure than did subjects with missing teeth (P=0.021). The former tended to have lower systolic blood pressure than did the latter (P=0.058). There were no significant differences in other variables between subjects with and without missing teeth. The odds ratio of having hypertension in subjects with missing teeth was 3.59 (95% confidence interval, 1.10 to 11.7) after adjustment of obesity, hypercholesterolemia, and hypertriglyceridemia. Our results suggest that hypertension may be an important factor linking tooth loss and an increased risk of vascular diseases in postmenopausal women.

Adult↗
PubMed2004

Pattern of tooth loss in recipients of free dental treatment at the University Hospital of Amman, Jordan.

The aim of this study is to document reasons for tooth loss in disadvantaged Jordanians who seek free dental care at the University Hospital/Dental Clinics. A 4-year (1998-2001) prospective study was undertaken involving 2200 randomly selected patients from this subpopulation. Of their 3069 lost teeth, 46.9% were lost due to caries and its sequel; 18% were lost because of periodontal disease; 8% were lost for a combination of caries and periodontal disease; 19.4% for pre-prosthetic reasons; 4% for orthodontic reasons; 2.8% for eruption problems and 0.7% due to trauma. Logistic regression analysis for reasons of tooth loss in this sector revealed that caries and its sequel was the predominant cause of tooth loss in patients <or=40 years of age whereas periodontal extractions were predominant for the above 40-year-old group. In addition, the most frequently extracted teeth, due to caries, were lower first and second molars while lower incisors were most commonly extracted for periodontal disease. Premolars were extracted for orthodontic reasons, upper incisors for trauma, third molars for eruption problems and canines for pre-prosthetic reasons. In conclusion, dental caries was the main reason for removal of teeth in adults attending the University of Jordan free dental casualty clinic. Therefore, in order to reduce the rate of dental extractions in this sector of the Jordanian population, efforts should focus on prevention and treatment of caries. Efforts should also be made to change the values and beliefs of this sector towards the importance of natural dentition.

Adult↗
PubMed2003

Risk factors for tooth loss in the institutionalised elderly; a six-year cohort study.

OBJECTIVE: The aim of this study was to examine risk factors for tooth loss and edentulism in institutionalised elderly people. DESIGN: Six-year prospective cohort study. SETTING: Twenty nine of the 30 institutions for elderly people in Kitakyushu, Japan. SUBJECTS: Four hundred and eighteen of the 1,096 subjects who were dentate at the baseline examination. OUTCOME MEASURES: Factors that influenced tooth loss and edentulism. RESULTS: In both sexes, older subjects had fewer remaining teeth at baseline. Males lost more teeth than females, and edentulism was also more likely in males than in females. Stepwise multiple linear regression analysis showed that the number of teeth, number of decayed teeth, periodontal pocket depth, and plaque index were significant predictors for the number of teeth lost. The incidence of edentulism was higher in males than in females. Stepwise multiple logistic regression analysis revealed that poorer mental health status, fewer teeth, having deep periodontal pocket, and poorer oral hygiene status were independently associated with the six-year incidence of edentulism. CONCLUSIONS: Tooth loss in institutionalised elderly people in Japan is related to both poor oral health status and poor mental health status.

Aged↗
PubMed1997

The reasons for tooth loss in geriatric patients attending two surgical clinics in Jerusalem, Israel.

OBJECTIVES: Numerous studies around the world have been conducted in order to understand the reasons for tooth extractions in various age groups. Most studies have dealt with the general adult population but little attention has been paid to the elderly population. In Israel, as in most of the western countries, the elderly population is growing rapidly and thus demands for its dental needs are also increasing. In order to meet the dental requirements of the geriatric population, data on the main reasons of tooth mortality have been collected. DESIGN: Retrospective analysis of reasons for extraction divided into three categories: caries, periodontal disease and "other". SUBJECTS: The files of 302 consecutive elderly patients aged 65-95 years attending for extraction. The cause for tooth extraction was gathered from the written diagnosis described by the operator as well as from radiographs. Setting Two surgical clinics in Jerusalem serving low income residents. Results Results indicated that 30% of the extractions were due to caries, 65% were due to periodontal disease and only 6.4% related to "other" reasons. In both, males and females, periodontal disease was the major cause for tooth loss yet, females exhibited more extractions due to caries than males (35% vs 23% respectively). A relatively high incidence of tooth loss was documented for the 85+ age group. Of the teeth that were extracted, incisors and molars were equally the most frequent (29%) followed by premolars (26%) and canines (17%). Premolars were the teeth most frequently extracted out of the teeth removed due to caries (32%) whereas incisors were the most frequently removed within the group of teeth extracted due to periodontal disease (31%). CONCLUSIONS: The results of this study point to the importance of prevention and treatment of dental diseases, particularly periodontal disease, in adults aged 0 years and above in order to prevent tooth loss in their later years.

Aged↗
PubMed2005

Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis.

Avulsed permanent teeth were replanted following immediate extraoral endodontic treatment by insertion of posts from a retrograde direction. Some teeth were rescued in a physiologic environment (tissue culture medium contained in a tooth rescue box), and in some cases antiresorptive-regenerative therapy (ART) was used. The aim of the study was to identify variables that influence the incidence of tooth loss and the survival of avulsed and replanted permanent incisors. Twenty-eight permanent teeth in 24 patients aged 7-17 years were investigated. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. All nine teeth with functional healing (FH) were in situ. Of the 19 teeth with non-FH, seven were removed to allow transplantations. Two teeth were removed due to severe infrapositions. One tooth was lost following a new trauma. No tooth was lost due to acute infections. In descriptive statistics the incidence of tooth loss was significantly related to healing (P = 0.0098, Fisher's exact test), to treatment planning, i.e. consecutive replantation of premolars and primary canines (P = 0.0001, Fisher's exact test) and to immediate physiologic rescue (P = 0.0394). ART was related to tooth loss when tested in teeth with a compromised periodontal ligament (P = 0.0389). No influence could be found for the parameters maturity, age and all other factors. In a regression analysis treatment planning was the only factor left which had a significant influence (P = 0.0002). The estimated mean survival time (Kaplan-Meier analysis) for all teeth was 57.3 months. The survival was significantly reduced (P = 0.0002, log rank test) when consecutive transplantations were intended and performed. No influence could be found for maturity, age and all other factors. The different findings to previous studies can be explained by the prevention of complications related to conventional endodontic treatment approaches. Statistics have to be carefully interpreted due to case preselection which is determined by the treatment guidelines and actual treatment options of the individual treating dentist.

Adolescent↗
PubMed1986

Tooth loss as related to dental caries and periodontal breakdown in adult Tanzanians.

A total of 170 adults aged 30-69 yr from the Zanzibar and Pemba Islands (Tanzania) were examined for tooth loss, dental caries and loss of periodontal attachment. The cause of tooth loss was recorded from information given by the examinee to a Kiswahili-English interpreter. Dental caries were recorded according to the depth of the lesion, i.e. involving enamel, dentin or pulp, respectively. Loss of attachment was measured as the distance in mm from the CEJ to the bottom of the pocket. The most severely affected surface determined the state of the tooth. The mean number of teeth present ranged from 29.5 in the youngest to 23.9 in the oldest age group. The mean number of teeth missing due to dental caries ranged between 2.1 and 7.0 teeth, and exceeded by far tooth loss due to periodontal breakdown which was only observed in the two oldest age groups. In all age groups the molars were the teeth most frequently missing and also the teeth most frequently affected by dental caries. Although a substantial number of the teeth in the older age groups demonstrated an extensive loss of attachment only a few teeth, mainly mandibular incisors, were lost due to periodontal breakdown within the age range examined.

Adult↗
PubMed1995

Relative contribution of caries and periodontal disease in adult tooth loss for an HMO dental population.

OBJECTIVES: This study examined the reasons for tooth loss in an adult population with dental insurance. METHODS: Computerized records were used to identify Kaiser Permanente Dental Care patients aged 40-69 years who had an extraction during 1992 (n = 1,877). A random sample of 839 dental charts were reviewed. RESULTS: Slightly more than 51 percent of the teeth were extracted for periodontal disease, 35.4 percent for caries, 9.5 percent for a combination of the two, and 3.5 percent for other reasons. When considering patients as the unit of analysis, 58.4 percent of the patients had an extraction for caries, 39.9 percent for periodontal disease, 5.0 percent for both, and 2.6 percent for other reasons. CONCLUSIONS: In this population both caries and periodontal disease play a role in tooth loss. For this reason, prevention programs focusing on the prevention of both disease processes should be developed for adults.

Adult↗
PubMed2006

Gingivitis, dental caries and tooth loss: risk factors for cardiovascular diseases or indicators of elevated health risks.

OBJECTIVES: The results of earlier studies connecting dental diseases to cardiovascular diseases are inconsistent. Our aim in this cross-sectional study was to investigate whether there are associations of dental diseases and diagnosed angina pectoris among the 1966 Northern Finland Birth Cohort. MATERIALS AND METHODS: A postal questionnaire was sent to all cohort members in 1997-1998. The number of replies totalled 8690. Angina pectoris was determined by asking whether the respondent had been diagnosed with angina pectoris. Gingivitis, dental caries and tooth loss were determined on the basis of self-reported gingival bleeding, presence of dental caries and six or more missing teeth. RESULTS: We found overall associations of gingivitis (odds ratio (OR) 1.52, confidence interval (CI) 1.04-2.22), dental caries (OR 1.50, CI 1.04-2.18) and tooth loss (OR 1.53, CI 0.69-3.42) with the presence of angina pectoris. The associations were modified by gender and socioeconomic status. In addition, gingivitis, dental caries and tooth loss were also associated with several cardiovascular risk factors. CONCLUSION: There were associations of self-reported gingivitis, dental caries and tooth loss with angina pectoris. However, the associations between dental diseases and cardiovascular risk factors suggest that the associations may be because of confounding.

Adult↗
PubMed1995

Self-reported tooth loss and bone mineral density in older men and women.

It has been reported that postmenopausal women with osteoporosis have a higher than expected number of dentures and fewer teeth than women without osteoporosis. The relationship between self-reported tooth loss and bone mineral density (BMD) at the hip and spine in 608 men and 874 women, aged 65-76 years, was examined in a cross-sectional study. BMD was measured using dual X-ray absorptiometry. Twenty-four per cent of men and 27% of women had no natural teeth. There was a consistent decrease in BMD with increasing numbers of teeth lost in men. This relationship was independent of age, body mass index and smoking habit (trochanter r = -0.14, p < 0.0005; Ward's triangle r = -0.1, p < 0.005; and lumbar spine r = -0.07, p < 0.05) with between 5% and 9% difference in mean BMD at various sites between men who had all their teeth and men who had no teeth. There was no significant association between self-reported tooth loss and BMD in women. Tooth loss is associated with lower BMD in men; this relationship is less consistent in women.

Aged↗
PubMed2005

Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort.

BACKGROUND: Tooth loss has previously been associated with a higher risk of cancer, heart disease, and stroke, but the role of confounding by smoking remains an issue. METHODS: We conducted a cohort study including 29,584 healthy, rural Chinese adults who were participants in a chemoprevention trial from 1986 through 1991 and who have been followed-up through 2001. We categorized tooth loss for each subject as less than or equal to or greater than the median number of teeth lost for other subjects of the same age at baseline. Mortality outcomes were categorized as follows: total death (n = 9362), upper gastrointestinal (GI) cancer death (n = 2625), other cancer death (n = 514), heart disease death (n = 1932), and fatal stroke (n = 2866). RESULTS: Individuals with greater than the age-specific median number of teeth lost had statistically significant 13% increased risk of total death [95% confidence interval (CI) 9-18%], 35% increased risk of upper GI cancer death (95% CI 14-59%), 28% increased risk of heart disease death (95% CI 17-40%), and 12% increased risk of stroke death (95% CI 2-23%), but no significantly increased risk of death from cancer at other sites. These elevated risks were present in male smokers, male non-smokers, and females, nearly all never-smokers. CONCLUSIONS: In this Asian population, tooth loss significantly increased the risk of total death and death from upper GI cancer, heart disease, and stroke. These associations were not limited to tobacco smokers.

Adult↗
PubMed1989

Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care.

Records of 63 patients diagnosed as having moderate periodontitis who had been treated and maintained by scaling and root planing for 10 years or longer (mean 13.6 years, range 10 to 34 years) in dental school clinics were reviewed for tooth loss. The patients averaged 45 years of age (range 24 to 67 years) at the initial appointment, and 41 were female. Record audit determined type of periodontal treatment, total tooth loss, periodontally related tooth loss, loss of teeth with furcation invasion, plaque scores, and maintenance interval. Results of therapy were evaluated by groups on the basis of number of teeth lost. At the completion of active periodontal therapy 1,607 teeth were present in the patients. During the maintenance period, 115 teeth (7.1%) were lost and of these 88 (5.0%) were lost due to periodontal reasons. Maxillary and mandibular molar teeth, particularly maxillary second molars, were the teeth lost most frequently to periodontal disease. Of the 164 teeth initially indicated as having furcation invasion, 23% were subsequently lost. This retrospective study confirms the low rate of tooth mortality occurring when patients with periodontal disease are treated and kept on a maintenance program. Canines were the teeth least frequently lost.

Adult↗
PubMed2002

Tooth loss and pocket probing depths in compliant periodontally treated patients: a retrospective analysis.

BACKGROUND/AIMS: This retrospective study determined the treatment outcomes of 142 compliant periodontal patients observed for at least 10 years at the University of Kiel. All patients had been treated for moderate to advanced periodontitis and regularly received supportive periodontal therapy (SPT). METHODS: Patient- and tooth-related variables [tooth loss and pocket probing depth (PPD)] were analysed. RESULTS: Of a total of 3353 teeth, 167 were extracted during active treatment and 99 during SPT, mainly for periodontal reasons. Forty-five per cent of the patients did not lose any teeth during 11.7 years of observation. Thirty-seven per cent underwent extractions during active treatment or SPT, 18% both during active periodontal therapy and SPT. Mean tooth loss per patient was 0.07 teeth/year during SPT. Mobility, furcation involvement, smoking, and prescription antibiotics had a negative impact on prognosis. Intraindividual differences in PPD were significant between single- and multirooted teeth with initial PPD > or = 4 mm at baseline, following active treatment and at the end of SPT, and between firm and mobile teeth at baseline. Interindividual differences in mean PPD were only significant between smokers and non-smokers at the end of the observation period. CONCLUSIONS: Long-term maintenance of our patients was effective. Periodontal disease represented the major cause of tooth loss in a minority of the population.

Adult↗
PubMed1994

Smoking as an additional risk for tooth loss.

Epidemiological studies have shown that loss of teeth is associated with increasing age. This was explained as the result of the action of microorganisms which, as components of dental plaque, destroyed the tooth by causing caries or periodontitis. Routine prevention programs therefore concentrated on removal of plaque, resulting in good oral hygiene. Despite good oral hygiene some individuals developed periodontitis. Studies have indicated that smoking may be a risk factor for this disease. This study was undertaken to determine whether or not smoking is also a risk factor for tooth loss. A total of 273 individuals were followed for 10 years, during which 93 individuals lost a total of 260 teeth. Younger individuals and especially males smoking more than 15 cigarettes a day were found to have the highest relative risk of losing teeth (4.55 and 3.18 respectively). In the younger age groups the proportional attributable risk was also highest; 78% for smokers smoking more than 15 cigarettes a day. The combination of a high plaque score and smoking was, together with age, the strongest predictor of tooth loss. The findings of this study suggest that smokers, especially those in the age group < 50 years, are a high risk group for tooth loss.

Adult↗