The reasons for tooth extractions in adults and their validation

Biphasic Calcium Phosphate in the Extraction Socket Preservation: A Systematic Review

Introduction

Various studies have suggested use of socket grafting materials after dental extraction for socket preservation. However, there is no single material that has been accepted as standard for preserving the socket. The purpose of this systematic review was to analyze the evidence for the use of biphasic calcium phosphate for socket regeneration.

Materials and Methods

The team conducted a systematic literature search in accordance with the protocol registered at PROSPERO. PubMed, OVID, and EMBASE databases were used in the search. The articles were then screened using RAYYAN open-source software for the synthesis of evidence.

Results

Of the 240 articles found in the search, two studies could be included in the review.

Conclusion

Biphasic calcium phosphate (60% hydroxyapatite, HA and 40% beta-tricalcium phosphate, β-TCP) has a significant effect in the socket preservation and quality of bone regeneration.

Effects of different signaling pathways on odontogenic differentiation of dental pulp stem cells: a review

Dental pulp stem cells (DPSCs) are a type of mesenchymal stem cells that can differentiate into odontoblast-like cells and protect the pulp. The differentiation of DPSCs can be influenced by biomaterials or growth factors that activate different signaling pathways in vitro or in vivo. In this review, we summarized six major pathways involved in the odontogenic differentiation of DPSCs, Wnt signaling pathways, Smad signaling pathways, MAPK signaling pathways, NF-kB signaling pathways, PI3K/AKT/mTOR signaling pathways, and Notch signaling pathways. Various factors can influence the odontogenic differentiation of DPSCs through one or more signaling pathways. By understanding the interactions between these signaling pathways, we can expand our knowledge of the mechanisms underlying the regeneration of the pulp-dentin complex.

Patterns of Tooth Extraction at a Student Dental Clinic in Palestine

INTRODUCTION

While the ideal approach in dentistry is to preserve teeth and restore their functionality within the oral cavity, there are circumstances where tooth extraction becomes a necessary and routine dental procedure. In cases where preserving the tooth is not feasible due to unavoidable reasons, extraction may be the preferred choice to ensure the attainment of stable oral health. So, the present study aims to elaborate on the trends in extraction in student dental clinics in Palestine.

MATERIALS AND METHODS

The present study is a cross-sectional study. Informed consent was obtained from the participants before enrolling in the study. Patients from all the departments undergoing extraction procedures were included in the present study. Patient information such as age, sex, and main reason for tooth extraction was collected. A dental record was noted for the number of teeth extracted, the type of the teeth, and the condition of the teeth extracted. All the data collected was entered in the spreadsheet, and frequency was calculated for each variable.

RESULTS

The present study showed that third molars were the most extracted teeth, and dental caries was the primary cause of extraction. In the "clearance cases," lower canines were the most commonly extracted teeth. In the "non-clearance cases," lower incisors and lower first molars were the most commonly extracted teeth.  Conclusion: The present study gives an overview of tooth extraction patterns in student dental clinics in Palestine. Further studies are required to evaluate and compare the prevalence and causes of tooth loss in different settings.

Biomechanical behavior of implants with different diameters in relation to simulated bone loss- an in vitro study

OBJECTIVES

Bone resorption around implants could influence the resistance of the implant abutment complex (IAC). The present in vitro study aimed to assess the stability to static fatigue of implants presenting different levels of bone losses and diameters.

MATERIALS AND METHODS

Ninety implants with an internal conical connection with 3 different implant diameters (3.3 mm (I33), 3.8 mm (I38), and 4.3 mm (I43)) and 3 simulated bone loss settings (1.5 mm (I_15), 3.0 mm (I_30), and 4.5 mm (I_45) (n = 10)) were embedded and standard abutments were mounted. All specimens were artificially aged (1,200,000 cycles, 50 N, simultaneous thermocycling) and underwent subsequently load-to-fracture test. For statistical analysis, Kolmogorov-Smirnov test, Kruskal-Wallis test, and Mann-Whitney U test (p < 0.05) were applied.

RESULTS

All test specimens withstood the artificial aging without damage. The mean failure values were 382.1 (± 59.2) N (I3315), 347.0 (± 35.7) N (I3330), 315.9 N (± 30.9) (I3345), 531.4 (± 36.2) N (I3815), 514.5 (± 40.8) N (I3830), 477.9 (± 26.3) N (I3845), 710.1 (± 38.2) N (I4315), 697.9 (± 65.2) N (I4330), and 662.2 N (± 45.9) (I4345). The stability of the IACs decreased in all groups when bone loss inclined. Merely, the failure load values did not significantly differ among subgroups of I43.

CONCLUSIONS

Larger implant diameters and minor circular bone loss around the implant lead to a higher stability of the IAC. The smaller the implant diameter was, the more the stability was affected by the circumferential bone level.

CLINICAL RELEVANCE

Preserving crestal bone level is important to ensure biomechanical sustainability at implant systems with a conical interface. It seems sensible to take the effect of eventual bone loss around implants into account during implant planning processes and restorative considerations.

Why and when older people lose their teeth: A study of public healthcare patients aged 60 years and over in 2007-2015

OBJECTIVES

This register-based study on public sector patients aged 60 years and over assessed annual age-specific volume of and reasons for tooth extractions as well as changes in these across the period 2007-2015.

BACKGROUND

Alongside the rapidly ageing population, the demand for public oral healthcare services is growing. Damaged teeth may induce a long-lasting inflammation burden in old age.

MATERIALS AND METHODS

Data used the electronic documentation of oral healthcare procedures recorded according to healthcare regulation. The study population consisted of all patients over 60 years of age (n = 216 059) who were treated 2007-2015 in public oral health care available to all citizens of Helsinki, Finland. Data for the 9-year time series included reasons for tooth extractions and were aggregated by patient age into 5-year groups. Statistical analyses included rates and proportions, mean values, correlation coefficients and linear regression modelling.

RESULTS

Extraction patients (n = 48 623) were more likely in the older age groups: 21.8% in the age group 60-64 and 27.5% in the age group 90+. Mean number of tooth extractions among all patients was 0.4 per patient and 1.7 per extraction patient. Among all tooth extractions (n = 82 677), main reasons were caries 29.5%, apical periodontitis 19.4%, tooth remnant 19.4% and periodontitis 18.0%. Tooth remnant predominated as extraction reason in the oldest age groups, while apical periodontitis displayed an upward trend by calendar year.

CONCLUSION

Tooth extractions attributable to caries were common in all old-age groups, tooth remnant extractions were most common in older age groups, and apical periodontitis abounded as extraction reason during 2007-2015.

Tooth loss and regional grey matter volume

OBJECTIVES

To investigate whether tooth loss was associated with regional grey matter volume (GMV) in a group of community dwelling older men and women from Ireland.

METHODS

A group of 380 dementia-free men and women underwent a dental examination and had a Magnetic Resonance Imaging (MRI) scan as part of The Irish Longitudinal Study of Aging (TILDA). Cortical parcellation was conducted using Freesurfer utilities to produce volumetric measures of gyral based regions of interest. Analysis included multiple linear regression to investigate the association between tooth loss and regional GMVs with adjustment for various confounders.

RESULTS

The mean age of participants was 68.1 years (SD 7.3) and 51.6% of the group were female. 50 (13.2%) of the participants were edentulous, 148 (38.9%) had 1-19 teeth, and 182 (47.9%) had ≥20 teeth. Multiple liner regression analysis with adjustment for a range of potential confounders showed associations between the number of teeth and GMVs in the paracentral lobule and the cuneus cortex. In the paracentral lobule, comparing participants with 1-19 teeth versus edentates there was an increase in GMV of β=323.0mm³ (95% Confidence Interval [CI] 84.5, 561.6) and when comparing participants with ≥20 teeth to edentates there was an increase of β=382.3mm³ (95% CI 126.9, 637.7). In the cuneus cortex, comparing participants with ≥20 teeth to edentates there was an increase in GMV of β=380.5mm³ (95% CI 69.4, 691.5).

CONCLUSIONS

In this group of older men and women from Ireland, the number of teeth was associated with GMVs in the paracentral lobule and the cuneus cortex independent of various known confounders.

CLINICAL SIGNIFICANCE

Although not proof of causation, the finding that tooth loss was associated with regional reduced GMV in the brain may represent a potential explanatory link to the observed association between tooth loss and cognitive decline.

Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study

BACKGROUND

We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence.

METHODS

This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data.

RESULTS

Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74-3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86-3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41-4.64).

CONCLUSIONS

The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.

The Potential Application of Human Gingival Fibroblast-Conditioned Media in Pulp Regeneration: An In Vitro Study

Regenerative endodontic treatment based on tissue engineering has recently gained interest in contemporary restorative dentistry. However, low survival rates and poor potential differentiation of stem cells could undermine the success rate of pulp regenerative therapy. Human gingival fibroblast-conditioned medium (hGF-CM) has been considered a potential therapy for tissue regeneration due to its stability in maintaining multiple factors essential for tissue regeneration compared to live cell transplantation. This study aimed to investigate the potency of hGF-CM on stem cells from human dental pulp (DPSC) in pulp regeneration. A series of experiments confirmed that hGF-CM contributes to a significant increase in proliferation, migration capability, and cell viability of DPSC after H2O2 exposure. Moreover, it has been proved to facilitate the odontogenic differentiation of DPSC via qRT-PCR, ALP (alkaline phosphatase), and ARS (Alizarin Red S) staining. It has been discovered that such highly upregulated odontogenesis is related to certain types of ECM proteins (collagen and laminin) from hGF-CM via proteomics. In addition, it is found that the ERK pathway is a key mechanism via inhibition assay based on RNA-seq result. These findings demonstrate that hGF-CM could be beneficial biomolecules for pulp regeneration.

Bone-related polymorphisms and dental status in older men and women. Results of the longitudinal Pro.V.A. study

Background/purpose

Genetics plays a role in the susceptibility to periodontitis and tooth loss. Several studies examined the involvement of polymorphisms in candidate genes. We hypothesize that bone metabolism-related polymorphisms could be associated with the number of remaining teeth.

Materials and methods

Participants in the Pro.V.A. longitudinal Study: 3099 Italians (aged 65+ at baseline), 2196 at follow-up 1 (5yrs), 1641 at follow-up 2 (7yrs) underwent detailed interview and clinical-instrumental examination. Subjects, grouped by remaining teeth number (0, 1–7, 8–19, 20+), were genotyped for six different bone-related polymorphisms: collagen type Iα1 (COL1A1, Sp1, Ss alleles, n = 1068), vitamin D receptor (VDR, Fok I, Ff alleles, n = 300), calcitonin receptor (CALCR, Alu I, CT alleles, n = 1430), estrogen receptor alpha (ESR1, Pvu II and Xba I, Pp and Xx alleles, n = 1335 and n = 1324).

Results

COL1A1 associated with dental status: ss carriers had reduced incident tooth loss (p < 0.05). The low frequency of this genotype, 3.6% in the whole population, didn't grant sufficient statistical power to other findings, such as the lower prevalence of edentulism, consistent throughout the study. In men, CC genotype of CALCR was associated with higher tooth loss between follow ups (p < 0.05). Biochemical markers of inflammation didn't differ by genotype. Confounders such as diabetes, neoplasms, and smoking hampered the detrimental effect of S allele in the logistic regression analysis (OR = 0.67, 95% CI 0.4–1.0, p = 0.06).

Conclusion

The present study, demonstrating an association between tooth loss and COL1A1 and -in men- CALCR, contributes to the identification of genes involved in tooth loss and, possibly, susceptibility to periodontitis.

Long-term outcomes after peri-implantitis treatment and their influencing factors: a retrospective study

Purpose

This study aimed to determine the long-term outcomes after peri-implantitis treatment and the factors affecting these outcomes.

Methods

This study included 92 implants in 45 patients who had been treated for peri-implantitis. Clinical data on the characteristics of patients and their implants were collected retrospectively. The change in the marginal bone level was calculated by comparing the baseline and the most recently obtained (≥3 years after treatment) radiographs. The primary outcome variable was progression of the disease after the treatment at the implant level, which was defined as further bone loss of >1.0 mm or implant removal. A 2-level binary logistic regression analysis was used to identify the effects of possible factors on the primary outcome.

Results

The mean age of the patients was 58.7 years (range, 22–79 years). Progression of peri-implantitis was observed in 64.4% of patients and 63.0% of implants during an observation period of 6.4±2.7 years (mean±standard deviation). Multivariable regression analysis revealed that full compliance to recall visits (P=0.019), smoking (P=0.023), placement of 4 or more implants (P=0.022), and marginal bone loss ≥4 mm at baseline (P=0.027) significantly influenced the treatment outcome.

Conclusions

The long-term results of peri-implantitis treatment can be improved by full compliance on the part of patients, whereas it is impaired by smoking, placement of multiple implants, and severe bone loss at baseline. Encouraging patients to stop smoking and to receive supportive care is recommended before treatment.

Systemic inflammation and the relationship between periodontitis, edentulism, and all-cause mortality: A 17-year prospective cohort study

AIM

The aim was to investigate the role of systemic inflammation in the relationship between periodontitis, edentulism, and all-cause mortality in a group of men in Northern Ireland aged 58-72 years.

MATERIALS AND METHODS

A representative sample of 1558 men had a detailed dental examination between 2001 and 2003. The primary end point was death from any cause. Cox's proportional hazards model was used to assess the longitudinal relationship between periodontitis, edentulism, and all-cause mortality. Accelerated failure time modelling was performed to investigate the mediating role of systemic inflammation.

RESULTS

Mean age of the men at baseline was 64.3 (standard deviation 2.9) years. During a median follow-up of 17 years, 500 (32.1%) men died. After adjustment for confounding variables, compared to men with no/mild periodontitis, edentulous men had a hazard ratio for all-cause mortality of 1.52 (95% confidence interval [CI] 1.16-1.99) p < .01 and for those with severe periodontitis, it was 1.34 (95% CI 1.06-1.70) p = .01. Systemic inflammation accounted only for a minor mediating pathway effect of 10%.

CONCLUSIONS

There was evidence in this group of men that those who were edentulous or had severe periodontitis had a significantly increased risk of all-cause mortality. Systemic inflammation was not a major explanatory mediator of this association.

Evaluation of occlusal status of Japanese adults based on functional tooth units

OBJECTIVES

Although extensive national oral health data on dental caries and periodontal diseases in Japan are available, few studies have assessed the occlusal status of the Japanese population, and none are based on national survey data. The presence and prosthodontic conditions of the molar region are important for masticatory function, and the functional tooth unit (FTU) approach can be used to evaluate the occlusal status. Thus, using the national oral health survey data, this study investigated the occlusal status of the Japanese population using FTU.

METHODS

Overall, 3,605 adults (aged ≥20 years) who participated in the 2011 Japanese national oral health survey were included. FTUs were used as indices for evaluating the occlusal status. FTUs were calculated according to sex, age group, and the number of teeth present, and their associations were further analysed.

RESULTS

The number of teeth present, posterior teeth, and FTUs decreased with age in both men and women. In the age group of those ≥60 years, all only natural teeth-FTU (n-FTU) and natural teeth and artificial teeth from fixed prostheses or implant-supported FTU (nif-FTU) scores were <8. The total-FTU scores of all age groups, except the 60-69 and 70-79 years age groups, were >10.

CONCLUSION

This is the first study to use FTUs and national oral health survey data to investigate the occlusal status in the Japanese population. People aged ≥60 years who have low n-FTU or natural teeth and artificial teeth from fixed prostheses or implant-supported FTU scores or those aged 60-70 years who have the lowest total-FTU scores require careful evaluation of masticatory performance.

Residual periodontal ligament in extracted teeth - is it associated with indication for extraction?

BACKGROUND

Periodontal disease is a major cause of tooth loss. Few studies have evaluated the residual area of the periodontal ligament in extracted teeth and, to the best of our knowledge, none from Latin America have done so regarding indications for extraction. The aim of this study was to evaluate the residual periodontal ligament (RPL) with respect to indication for extraction in a sample of teeth from a Brazilian Public Health Service district.

MATERIALS AND METHODS

All teeth extracted within the Public Health Service district of Santa Maria, Brazil, over a 5-month period were requested for analysis. A total of 414 teeth eligible for measurement were stained and evaluated for RPL using a stereo microscope. Participating Public Health Service dentists completed a questionnaire detailing demographic variables and indication for each extracted tooth. The percentage of RPL was determined for each tooth. Comparisons of RPL between teeth extracted on periodontal versus other indications were made using the Mann-Whitney test.

RESULTS

RPL averaged 34.8% for teeth extracted on periodontal indications versus 79.5% for other teeth (P ≤ 0.001). When considering teeth with an RPL ≥ 30% as possible to maintain, 189 (76%) of the teeth extracted on periodontal indications could have been maintained. When RPL cut-off limits of ≥ 40% or ≥ 50% are applied, 93 (37%) and 43 (17%) teeth, respectively, could have been maintained.

CONCLUSION

This study suggests that strictly based on RPL, a large number of teeth extracted on periodontal indications conceivably could be maintained.

The epidemiology of edentulism and the associated factors: A literature Review

Considering the advancement of curative and preventive dentistry, edentulism is still a challenging problem for healthcare providers all over the world. Dental caries and periodontal diseases are the main causative factors to teeth loss and eventually, if untreated, lead to edentulism. The socioeconomical factors also contribute to the edentulism as it has an association with education and income status. This literature review will put some highlights in the epidemiology and etiology of edentulism, its prevalence, and the association with the social-economical factors.

Reasons for Tooth Extractions and Related Risk Factors in Adult Patients: A Cohort Study

Background: The aim of this study was to evaluate oral status, the reasons for tooth extractions and related risk factors in adult patients attending a hospital dental practice. Methods: 120 consecutive patients ranging from 23 to 91 years in age (mean age of 63.3 ± 15.8) having a total of 554 teeth extracted were included. Surveys about general health status were conducted and potential risk factors such as smoking, diabetes and age were investigated. Results: a total of 1795 teeth were missing after extraction procedures and the mean number of remaining teeth after the extraction process was 16.8 ± 9.1 per patient. Caries (52.2%) was the most common reason for extraction along with periodontal disease (35.7%). Males were more prone to extractions, with 394 of the teeth extracted out of the total of 554 (71.1%). Male sex (β = 2.89; 95% CI 1.26, 4.53; p = 0.001) and smoking habit (β = 2.95; 95% CI 1.12, 4.79; p = 0.002) were related to a higher number of teeth extracted. Age (β = −0.24; 95% CI −0.31, −0.16; p < 0.001) and diabetes (β = −4.47; 95% CI −7.61, −1.33; p = 0.006) were related to a higher number of missing teeth at evaluation time. Moreover, periodontal disease was more common as a reason of extraction among diabetic patients than among non-diabetic ones (p = 0.04). Conclusions: caries and periodontal disease were the most common causes of extraction in a relatively old study population: further screening strategies might be required for the early interception of caries and periodontal disease.

Association of Periodontal Disease and Edentulism With Hypertension Risk in Postmenopausal Women

BACKGROUND

Multiple cross-sectional epidemiologic studies have suggested an association between periodontal disease and tooth loss and hypertension, but the temporality of these associations remains unclear. The objective of our study was to evaluate the association of baseline self-reported periodontal disease and edentulism with incident hypertension.

METHODS

Study participants were 36,692 postmenopausal women in the Women's Health Initiative-Observational Study who were followed annually from initial periodontal assessment (1998-2003) through 2015 (mean follow-up 8.3 years) for newly diagnosed treated hypertension. Cox proportional hazards regression with adjustment for potential confounders was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Edentulism was significantly associated with incident hypertension in crude (HR (95% CI) = 1.38 (1.28-1.49)) and adjusted (HR (95% CI) = 1.21 (1.11-1.30)) models. This association was stronger among those <60 years compared to ≥60 years (P interaction 0.04) and among those with <120 mm Hg systolic blood pressure, compared to those with ≥120 mm Hg (P interaction 0.004). No association was found between periodontal disease and hypertension.

CONCLUSIONS

These findings suggest that edentulous postmenopausal women may represent a group with higher risk of developing future hypertension. As such improved dental hygiene among those at risk for tooth loss as well as preventive measures among the edentulous such as closer blood pressure monitoring, dietary modification, physical activity, and weight loss may be warranted to reduce disease burden of hypertension. Further studies are needed to clarify these results and further elucidate a potential role of periodontal conditions on hypertension risk.

The relationship between tooth loss and mortality from all causes, cardiovascular diseases, and coronary heart disease in the general population: systematic review and dose-response meta-analysis of prospective cohort studies

Background: The association of tooth loss with mortality from all causes, cardiovascular diseases (CVD), and coronary heart disease (CHD) has been studied for many years; however, the results are inconsistent.

Method: PubMed, Embase, Web of Knowledge, and Cochrane Oral Health Group’s Trials Register databases were searched for papers published from 1966 to August 2018. We conducted dose–response meta-analysis to quantitatively evaluate the relation between tooth loss and risk of mortality from all causes, CVD, and CHD.

Results: In the present study, 18 prospective studies conducted until August 2018 were considered eligible for analysis. In the analysis of linear association, the summarized relative risk (RR) values for each 10-, 20-, and 32-tooth loss for all-cause mortality were 1.15 (1.11–1.19), 1.33 (1.23–1.29), and 1.57 (1.39–1.51), respectively. Subgroup and sensitivity analyses showed consistent results. A linear relationship was found among all-cause mortality, with P_nonlinearity = 0.306. The susceptibility to all-cause mortality increased by almost 1.48 times at very high tooth loss (28–32), and slight flattening of the curve was noted. However, the summarized RR values for increment for 10-, 20-, and 32-tooth loss were not or were marginally related to increased risk of mortality from CVD/CHD. Subgroup and sensitivity analyses revealed inconsistent results. Tooth loss showed linear association with CHD mortality but not with CVD mortality. The susceptibility to all-cause mortality increased by almost 1.48 and 1.70 times for CVD and CHD, respectively, at very high tooth loss (28–32). The curve exhibited slight flattening; however, no statistical significance was detected.

Conclusion: In the meta-analysis, our findings confirmed the positive relationship between tooth loss and susceptibility to all-cause mortality, but not for circulatory mortality. However, the finding that tooth loss might play a harmful role in the development of all-cause mortality remains inconclusive. Tooth loss may be a potential risk marker for all-cause mortality: however, their association must be further validated through large prospective studies.

Association of clinical measures of periodontal disease with blood pressure and hypertension among postmenopausal women

BACKGROUND

Hypertension and periodontal disease are common conditions among postmenopausal women. Periodontal disease has been found associated with hypertension in previous studies, but data in postmenopausal women is limited.

METHODS

We assessed the cross-sectional associations of clinically measured periodontal disease with prevalent hypertension and measured systolic blood pressure (SBP) among 1341 postmenopausal women enrolled in the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study, an ancillary study of the Women's Health Initiative-Observational Study.

RESULTS

Clinical attachment level (CAL) and number of teeth missing were positively associated with SBP among those not taking antihypertensive medication in crude and multivariable adjusted linear regression models (both P < 0.05). Alveolar crestal height (ACH) and gingival bleeding on probing were associated with higher SBP in crude but not multivariable adjusted models. Neither probing pocket depth (PPD) nor severity categories of periodontitis were associated with SBP. Number of teeth missing was significantly associated with prevalent hypertension in crude and multivariable adjusted models (OR = 1.14, per 5 teeth; P = 0.04). ACH was associated with prevalent hypertension in crude but not adjusted models. CAL, PPD, gingival bleeding, and severity of periodontitis were not significantly associated with prevalent hypertension.

CONCLUSIONS

These results suggest that measures of oral health including CAL and number of teeth missing are associated with blood pressure in postmenopausal women. Prospective studies are needed to further investigate these associations and the potential underlying mechanisms for these relationships.

Periodontitis, edentulism and glycemic control in patients with type 2 diabetes: a cross-sectional study

OBJECTIVES

To compare the glycemic control in non-smoking patients with type 2 diabetes according to their periodontal and dental status.

RESEARCH DESIGN AND METHODS

This cross-sectional study investigated patients previously diagnosed with type 2 diabetes and under antidiabetic medication. Clinical data and fasting blood glucose (FBG) levels were collected from medical and dental records. Patients were divided into three groups according to dental and periodontal diagnosis: no or mild periodontitis (NO/MILD, n=96), moderate or severe periodontitis (MOD/SEV, n=74) and edentulous (n=141). FBG levels were compared between groups. Logistic regression was also applied to estimate the OR of presenting hyperglycemia.

RESULTS

Edentulous patients had significantly higher FBG levels of 155.7±70.9 (mean±SD mg/dL) than those in the MOD/SEV (136.6±33.8) and the NO/MILD (123.1±36.7) groups. Differences between the latter two groups were also significant. Edentulous patients had adjusted ORs of 4.53, 4.27 and 3.95 of having FBG≥126, ≥150 and ≥180 mg/dL, respectively, in comparison with NO/MILD group. The MOD/SEV group also presented significant odds of having FBG≥126 mg/dL (OR=2.66) and ≥150 mg/dL (OR=2.45) than the NO/MILD group.

CONCLUSIONS

Patients in the MOD/SEV group had worse glycemic control than the ones in the NO/MILD group. However, edentulous patients presented higher glycemic levels than both dentate groups, and also presented with higher odds of having hyperglycemia.

Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis

BACKGROUND

Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs).

OBJECTIVES

To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria.

MAIN RESULTS

We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution.

AUTHORS' CONCLUSIONS

Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.

Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease

BACKGROUND

Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss- a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial.

METHODS AND RESULTS

Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels and biomarker levels, and the relationship between tooth loss levels and outcomes, respectively. After multivariable adjustment, the relative biomarker increase between the highest and the lowest tooth loss level was: high-sensitivity C-reactive protein 1.21 (95% confidence interval, 1.14-1.29), interleukin 6 1.14 (1.10-1.18), lipoprotein-associated phospholipase A₂ activity 1.05 (1.03-1.06), growth differentiation factor 15 1.11 (1.08-1.14), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1.18 (1.11-1.25). No association was detected for high-sensitivity troponin T 1.02 (0.98-1.05). Some attenuation of the relationship between tooth loss and outcomes resulted from the addition of biomarkers to the multivariable analysis, of which NT-proBNP had the biggest impact.

CONCLUSIONS

A graded and independent association between tooth loss and several prognostic biomarkers was observed, suggesting that tooth loss and its underlying mechanisms may be involved in multiple pathophysiological pathways also implicated in the development and prognosis of CHD. The association between tooth loss and cardiovascular death and stroke persisted despite comprehensive adjustment including prognostic biomarkers.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov; NCT00799903.

Permanent tooth loss and sugar-sweetened beverage intake in U.S. young adults

OBJECTIVE

In young adults, sugar-sweetened beverage (SSB) intake is associated with dental caries, which in turn is a major contributor to tooth loss. The independent role of SSB intake on tooth loss, however, has not been well-described. This cross-sectional study examined associations between tooth loss and SSB intake among U.S. young adults.

METHODS

The outcome was number of permanent teeth lost because of dental caries or periodontal disease (0, 1-5, ≥6 teeth). Data from the 2012 Behavioral Risk Factor Surveillance System were used. The 22,526 adults aged 18-39 years completed the Sugar Drink Module. The exposure variable was daily frequency of SSB intake. We used multinomial logistic regression to examine the adjusted associations between tooth loss and daily SSB consumption (0, >0 to <1, 1-2, >2 times/day).

RESULTS

Approximately, 26% of young adults reported losing at least one permanent tooth. Tooth loss was positively associated with SSB intake frequency; the odds of losing 1-5 teeth were higher among adults drinking SSBs >0-<1 times/day (OR = 1.44, 95%CI = 1.16-1.79), 1-2 times/day (OR = 1.58, 95%CI = 1.25-1.99), and >2 times/day (OR = 1.97, 95%CI = 1.51-2.58) than non-SSB consumers. The odds of losing ≥6 teeth were higher among adults drinking SSBs 1-2 times/day (OR = 2.20, 95%CI = 1.15-4.22) and >2 times/day (OR = 2.81, 95%CI = 1.37-5.76) than non-SSB consumers.

CONCLUSIONS

Frequency of SSB consumption was positively associated with tooth loss among young adults even when the average SSB intake was less than one time per day. This study suggests that efforts to reduce SSB intake among young adults may help to decrease the risk of tooth loss.

[Effect of dental arch length decrease during orthodontic treatment in the upper airway development. A review]

INTRODUCTION

A possible relation between an upper airway space decrease and the development of obstructive sleep apnea syndrom explains the importance to know the effect of the modification of dental arch length on the upper airway during orthodontic treatment.

OBJECTIVES

The aim of this article is to expose recent knowledge about upper airway development and dental arch length decrease factors, to determine the influence of this decrease on upper airway development.

METHODS

A review was done to determine the upper airway normal development, to define dental arch to specify if an ideal position of dental arch on apical base exists. All of the length dental arch decrease factors during orthodontic treatment (dental extraction, dental agenesis and dental malpositions) and their upper airway resounding were searched.

RESULTS

Some authors found a diminution of upper airway space after premolars extractions while others didn't found this diminution after extractions premolars when incisor retraction is finished. A decrease of transversal maxillary diameter and nasal cavity may be due to absence of permanent teeth.

CONCLUSION

The effect of dental arch length decrease during orthodontic treatment in the upper airway development was not scientifically proved. However we had to be vigilant and adapt our orthodontic treatment case by case to avoid an upper airway modification.

Tooth loss is independently associated with poor outcomes in stable coronary heart disease

OBJECTIVE

We investigated associations between self-reported tooth loss and cardiovascular outcomes in a global stable coronary heart disease cohort.

METHODS

We examined 15,456 patients from 39 countries with stable coronary heart disease (prior myocardial infarction, prior revascularisation or multivessel coronary heart disease) in the STABILITY trial. At baseline, patients reported number of teeth (26-32 (all), 20-25, 15-19, 1-14 and no teeth) and were followed for 3.7 years. Cox regression models adjusted for cardiovascular risk factors and socioeconomic status, determined associations between tooth loss level (26-32 teeth: lowest level; no teeth: highest level) and cardiovascular outcomes.

RESULTS

After adjustment, every increase in tooth loss level was associated with an increased risk of the primary outcome, the composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke (hazard ratio 1.06; 95% confidence interval 1.02-1.10), cardiovascular death (1.17; 1.10-1.24), all-cause death (1.16; 1.11-1.22) and non-fatal or fatal stroke (1.14; 1.04-1.24), but not with non-fatal or fatal myocardial infarction (0.99; 0.94-1.05). Having no teeth, compared to 26-32 teeth, entailed a significantly higher risk of the primary outcome (1.27 (1.08, 1.49)), cardiovascular death (1.85 (1.45, 2.37), all-cause death (1.81 (1.50, 2.20)) and stroke (1.67 (1.15, 2.39)).

CONCLUSIONS

In this large global cohort of patients with coronary heart disease, self-reported tooth loss predicted adverse cardiovascular outcomes and all-cause death independent of cardiovascular risk factors and socioeconomic status.

Treatment of caries in relation to lesion severity: implications for minimum intervention dentistry

OBJECTIVES

To date there is little evidence of minimum intervention in relation to treatment patterns, particularly for initial carious lesions. The objective of this study was to investigate treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion.

METHODS

A random sample of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on services, patient characteristics and main diagnosis were collected from a service log.

RESULTS

Models of service rates adjusted for age, sex, insurance status and reason for visit showed that compared to the reference category of gross caries lesions, there were higher rates [rate ratio, 95% CI] of restorative services for initial [1.63, 1.31-2.03] and cavitated [1.69, 1.39-2.05] lesions, higher rates of prophylaxis for initial [3.77, 2.09-6.79] and cavitated [3.88, 2.29-6.58] lesions, lower rates of endodontic services for initial [0.07, 0.02-0.30] and cavitated [0.11, 0.04-0.30] lesions, and lower rates of extraction for initial [0.15, 0.06-0.34] and cavitated [0.15, 0.07-0.31] lesions.

CONCLUSIONS

Treatment of coronal caries was characterized by high rates of restorative services, but gross lesions had lower restorative rates and higher rates of endodontic and extraction services. There was little differentiation in treatment of coronal caries between initial and cavitated lesions, suggesting scope for increased management of initial carious lesions by the adoption of more minimum intervention approaches.

Evaluation of reasons for extraction of crowned teeth: a prospective study at a university clinic

OBJECTIVE

The aim of this study was to determine and classify the major reasons for extraction of teeth with full crowns belonging to patients admitted to a university clinic within a specific time frame.

METHODS

Two hundred and eight extracted teeth with full crown belonging to 75 patients were included. Apart from demographic information, reasons for presenting to the hospital, the major reason for extraction, the type of the crown (single crown, bridge abutment, abutment for removable prosthesis), presence of posts, age of restorations, presence of an endodontic treatment and quality were recorded. Comparable data were statistically analyzed using the chi-square test.

RESULTS

Forty-three (57.3%) of the patients were females, whereas 32 (42.7%) were males with an average age of 63.21 ± 13.56. A statistically significant relationship was determined between age groups and rate of extractions, with the lowest extractions detected in the 35-44 years age group and the highest in the 55-64 years age group (p = 0.001). Tooth mobility was the predominant reason for patients' initial presentation (52.9%). The most encountered reason for extraction was periodontal reasons with a prevalence of 59.1%, followed by caries (26.9%) and periapical lesions (12%); 35.6% of extracted teeth had endodontic treatment. Sixty teeth (81.1%) had incomplete root fillings. There was a significant relationship between extractions and incomplete root fillings (p = 0.001).

CONCLUSION

Studies comprising other faculty clinics as well as general practices will be complementary in making more generalized statements regarding the etiology of extractions of crowned teeth.

Relative contribution of restorative treatment to tooth extraction in a teaching institution

Teeth can be extracted due to multiple factors. The aim of this retrospective cross-sectional study was to identify the relative contribution of restorative treatments to tooth loss. The study reviewed records of 826 patients (1102 teeth). Patient's gender, age and education were obtained. In addition to the main reason for extraction (caries, periodontal disease, pre-prosthetic extraction, restorative failure and remaining root), the following information was collected about each extracted tooth: type, the status of caries if any (primary or secondary) and pulpal status (normal or reversible pulpitis, irreversible pulpitis, necrotic or root canal treated) and type and size of restoration, if present. Following data collection, descriptive analysis was performed. A log-linear model was used to examine the association between restorative treatment and tooth loss and between reasons for tooth loss and type of tooth. Lower molars followed by upper molars were the most commonly extracted teeth. Teeth with no restorations or with crowns were less likely to be extracted (P < 0·001). Lower and upper molars and lower premolars were more likely to be extracted due to restorative failure, while lower anterior teeth were more likely to be extracted due to periodontal disease (P < 0·05). Twenty two per cent of the extractions was due to restorative failure, and at least 65·9% of these teeth had secondary caries. Gender, age and educational level were factors that affect tooth loss. In conclusion, teeth receiving multiple restorative therapies were more likely to be extracted.

Associations between smoking and tooth loss according to the reason for tooth loss: the Buffalo OsteoPerio Study

BACKGROUND

Smoking is associated with tooth loss. However, smoking's relationship to the specific reason for tooth loss in postmenopausal women is unknown.

METHODS

Postmenopausal women (n = 1,106) who joined a Women's Health Initiative ancillary study (The Buffalo OsteoPerio Study) underwent oral examinations for assessment of the number of missing teeth, and they reported the reasons for tooth loss. The authors obtained information about smoking status via a self-administered questionnaire. The authors calculated odds ratios (ORs) and 95 percent confidence intervals (CIs) by means of logistic regression to assess smoking's association with overall tooth loss, as well as with tooth loss due to periodontal disease (PD) and with tooth loss due to caries.

RESULTS

After adjusting for age, education, income, body mass index, history of diabetes diagnosis, calcium supplement use and dental visit frequency, the authors found that heavy smokers (≥ 26 pack-years) were significantly more likely to report having experienced tooth loss compared with never smokers (OR = 1.82; 95 percent CI, 1.10-3.00). Smoking status, packs smoked per day, years of smoking, pack-years and years since quitting smoking were significantly associated with tooth loss due to PD. For pack-years, the association for heavy smokers compared with that for never smokers was OR = 6.83 (95 percent CI, 3.40 -13.72). The study results showed no significant associations between smoking and tooth loss due to caries.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Smoking may be a major factor in tooth loss due to PD. However, smoking appears to be a less important factor in tooth loss due to caries. Further study is needed to explore the etiologies by which smoking is associated with different types of tooth loss. Dentists should counsel their patients about the impact of smoking on oral health, including the risk of experiencing tooth loss due to PD.

Edentulism in high poverty rural counties

PURPOSE

To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism.

METHODS

We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design.

FINDINGS

Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county.

CONCLUSIONS

Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism.

Reasons for permanent tooth extractions in Taiwan

There has been no study in Taiwan on reasons for extraction of permanent teeth. This study aimed to determine the reasons for permanent teeth extraction in Taiwan. This study performed a secondary data analysis based on the National Health Insurance Research Database. The 2009 database was adopted and there are 131 104 records of dental visits in the database; among them, 4958 visits (from 4811 patients) have a coding of extraction. The results showed that dental caries (55.3%) was the main reason for tooth extraction, followed by periodontal disease (22.1%). Extraction because of dental caries was commonly observed in all age-groups, and extractions because of periodontal disease increased in those older than 35 years. Maxillary and mandibular third molar were the most frequently removed tooth types, and most were extracted because of dental caries and impaction respectively.

Socio-cultural factors in dental diseases in the Medieval and early Modern Age of northern Spain

The aim of this study is to present, discuss and compare the results of pathological conditions in teeth from skeletal remains found in the northern part of the Iberian Peninsula (Spain) in four Medieval cemeteries (late 15th century) and three cemeteries from the Modern Age (late 18th century). The final objective was to evaluate the impact of socioeconomic and cultural changes that took place during the early Modern Age in Spain, on oral health. Dental caries and antemortem tooth loss were considered as indicators of dental disease. A significant increase of both dental caries and antemortem tooth loss occurred in Modern Age individuals when compared to Medieval values, as reported for other regions. Increased trade with other continents may explain this deterioration of dental health, as food exchanges (mainly with America) contributed to diet changes for the overall population, including higher carbohydrate consumption (introduction of potatoes) at the expense of other vegetables. A sex-specific increase of dental disease with age, and a significantly higher prevalence of carious lesions in Modern Age females than in males, were also found. These changes can be explained by women having had limited access to dental care after the Middle-Modern Age transition, as a consequence of socio-cultural and political changes. In these changes, an increasing influence of the Catholic Church in Spanish society has to be noted, as it can contribute to the explanation of the unequal dental health of men and women. Women were socially excluded from dental care by regulations inspired by religious precepts.

Reasons for extraction in a group of Libyan patients

AIMS AND OBJECTIVES

To investigate the pattern and causes of tooth loss in patients among eastern part of Libya.

MATERIALS AND METHODS

This study carried out at Faculty of Dentistry, Garyounis University, Benghazi, Libya. The out patients undergoing extractions at the Oral Surgery Department were randomly selected for this study between Jan 2007 and March 2008 where a total of 9,570 extractions were performed on 8,514 patients. The incidence and reasons for tooth extraction, their distribution according to age and sex were studied.

RESULTS

Males had more teeth extracted than females. Forty patients had one or more systemic illnesses, 34 were on regular medication. The study revealed two major causes of tooth loss: dental caries (55.90%) and periodontal diseases (34.42%). Other important causes were trauma (3.76%), impaction (1.83%), prosthodontic reasons (2.19%), and orthodontic reasons (1.30%) and others which included extraction where the tooth was associated with a tumour, cyst or supernumerary tooth (1.61%). Dental caries was the main causes of tooth loss during the 2nd, 3rd and 4th decades. While periodontal diseases were the prevalent aetiological factor during the 4th, 5th, 6th and 7th decades of life. The posterior teeth most frequently extracted due to dental caries were lower first molars (43.92%). Whereas anterior teeth were more frequently extracted due to periodontal diseases (28%) with the remaining posterior teeth also being extracted (7%).

Incidence and association of root fractures after prosthetic treatment

PURPOSE

Common reasons for tooth extractions include periodontal disease, dental caries and root fracture. The purpose of this study was to investigate the association of tooth loss after prosthetic treatment, particularly incidences due to root fracture, which occur frequently and are difficult to prevent.

METHODS

Data were collected from consecutively selected medical records of patients taken over 3 years after their initial visit to Osaka University Dental Hospital. Collected data included (1) age and gender, (2) number of teeth at the initial visit and number of extracted teeth, (3) reasons for extraction, (4) restored with or without a post and (5) abutment of removable partial dentures (RPDs). A Chi-squared test was applied among the reasons for extraction, whether the tooth was restored with a post or not and clasped or not. A logistic regression analysis was used to determine the associations of root fracture with the patient data.

RESULTS

This study included 101 patients (296 extracted teeth). The reasons for extraction included periodontal disease (64.6%), caries (25.3%) and root fracture (10.1%). The percentage of root fracture was significantly higher for female than male, for restored teeth with posts than without posts and for abutment of RPDs than for non-abutment teeth. Logistic regressions showed that root fractures were significantly associated with gender and abutments.

CONCLUSION

The most frequently stated reasons for tooth extraction after prosthetic treatment were periodontal disease and dental caries, followed by root fracture. Root fractures were significantly associated with gender and abutment teeth of RPDs.

Effect of reinforcement with resin composite on fracture strength of structurally compromised roots

This study was aimed at evaluating the fracture resistance of structurally compromised roots restored with four different post and core systems. Thirty-two bovine roots were uniformly shaped to simulate human mandibular premolar roots. The roots were divided into four groups based on the type of restoration: cemented cast post and core (Group MC), resin composite build-up (Group CR), resin composite and prefabricated glass fiber post build-up (Group FRC), and thick-layer dual-cured resin composite-reinforced small-diameter tapered cast post and core (Group CRM). After a static loading test, the failure mode and fracture resistance were recorded. Group CRM (719.38+/-196.73 N) exhibited a significantly high fracture resistance compared with the other groups (Group MC: 429.56+/-82.43 N; Group CR: 349.56+/-66.21 N; Group FRC: 398.94+/-112.71 N; p<0.05). In conclusion, Group CRM exhibited better mechanical properties for structurally compromised roots with no ferrules, although all types of restorations showed non-restorable fracture modes.

Influence of age on mastication: effects on eating behaviour

The present review covers current knowledge about the ageing of oral physiology related to mastication and its effects on eating behaviour. Mastication is the first process undergone by a food during feeding. It has a key role in the maintenance of nutritional status in two respects. First, the perceptions of food's sensory properties elicited during chewing and swallowing are one of the major determinants of the pleasure which drives us to eat; second, the properties of the swallowed bolus are affected by oral conditions and this may modulate the subsequent phases of digestion. Ageing in healthy dentate subjects induces moderate changes in oral physiology. Changes in neuromuscular activity are partly compensated by changes in chewing behaviour. No clear age effect is seen in texture perception, although this does impact on food bolus properties. In contrast, great alterations in both chewing behaviour and food bolus properties are observed when ageing is associated with a compromised dentition, general health alterations and drug intake. Eating behaviour is far more complex than just chewing behaviour and the concerns of the elderly about food cannot be explained solely by oral physiology. Discrepancies are often noticed with older subjects between various objective measurements of oral performance and corresponding measures of self-perception. In addition, although more foods are recognised as hard to chew with increasing age, there is no clear shift in preference towards food that is easy to chew. Food choices and food consumption are also driven by memory, psychology and economic factors. Advances in the understanding of food choice in the elderly need a sustained collaborative research effort between sensory physiologists, nutritionists, and food scientists.

National survey on edentulism and its geographic distribution, among Mexicans 18 years of age and older (with emphasis in WHO age groups)

To determine the prevalence of edentulism in adults aged 18 years and older in Mexico and to describe its distribution in 20 of the 32 States in Mexico, highlighting the experience in the WHO age groups. A secondary analysis of the National Performance Evaluation Survey 2002-2003 (representative at the state level and part of the Word Health Survey) was undertaken. The sample design was probabilistic, stratified and through conglomerates. Data on dental conditions were available only for 20 of the 32 states of Mexico, leading to a total of 24 159 households (N = 54 638 654). The percentage of edentulism was determined as the proportion of subjects that self-reported complete loss of teeth. Data were analyzed using the SVY module for complex surveys in STATA 8.2. The mean age was 41.3 +/- 17.0 years (range 18-99). An estimated 6.3% (N = 3 437 816) of the population > or =18 years was edentulous. Lowest prevalences were observed in the states of Tlaxcala, Puebla and the Estado de Mexico with 3.4%, 3.8% and 4.5%, respectively. Highest prevalences were observed in San Luis Potosí, Colima, and Michoacán with 10.3%, 10.2% and 10.1%, respectively. Following the WHO age groups, the prevalence ranged from 2.4% in the 35-44 group through 25.5% in the 65-74 group. No obvious association between socio-economic and socio-demographic indicators at the state level and prevalence of edentulism was found. The prevalence of complete tooth loss observed in the present study varied greatly across states, although no straightforward association was found with socio-economic and socio-demographic indicators at the state level. This study could serve as a baseline to enable future evaluations of the oral status of Mexican adults and elders, following WHO age groups.

Using NHANES oral health examination protocols as part of an esophageal cancer screening study conducted in a high-risk region of China

BACKGROUND

The oral health status of rural residents in the People's Republic of China has not been extensively studied and the relationship between poor oral health and esophageal cancer (EC) is unclear. We aim to report the oral health status of adults participating in an EC screening study conducted in a rural high-risk EC area of China and to explore the relationship between oral health and esophageal dysplasia.

METHODS

National Health and Nutrition Examination Survey (NHANES) oral health examination procedures and the Modified Gingival Index (MGI) were used in a clinical study designed to examine risk factors for esophageal cancer and to test a new esophageal cytology sampling device. This study was conducted in three rural villages in China with high rates of EC in 2002 and was a collaborative effort involving investigators from the National Institutes of Health and the Cancer Institute of the Chinese Academy of Medical Sciences.

RESULTS

Nearly 17% of the study participants aged 40-67 years old were edentulous. Overall, the mean number of adjusted missing teeth (including third molars and retained dental roots) was 13.8 and 35% had 7 contacts or less. Women were more likely to experience greater tooth loss than men. The average age at the time of first tooth loss for those with no posterior functional contacts was approximately 41 years for men and 36 years for women. The mean DMFT (decayed, missing, and filled teeth) score for the study population was 8.5. Older persons, females, and individuals having lower educational attainment had higher DMFT scores. The prevalence of periodontal disease (defined as at least one site with 3 mm of attachment loss and 4 mm of pocket depth) was 44.7%, and 36.7% of the study participants had at least one site with 6 mm or more of attachment loss. Results from a parsimonious multivariate model indicate that participants with poor oral health wemore likely to have esophageal dysplasia (OR = 1.59; 95% CI 1.06, 2.39).

CONCLUSION

This report describes the first use of NHANES oral health protocols employed in a clinical study conducted outside of the United States. The extent and severity of poor oral health in this Chinese study group may be an important health problem and contributing factor to the prevalence of EC.

Reasons for permanent tooth extractions in Japan

BACKGROUND

There has been no nationwide study in Japan on reasons for extraction of permanent teeth. This survey was aimed to determine the reasons for extraction of permanent teeth in Japan.

METHODS

Five thousand, one hudred and thirty-one dentists were selected by systematic selection from the 2004 membership directory of the Japan Dental Association. The dentists selected were asked to record the reason for each extraction of permanent teeth during a period of one week from February 1 through 7, 2005. Reasons for tooth extraction were assigned to five groups: caries, fracture of teeth weakened by caries or endodontics, periodontal diseases, orthodontics, and other reasons.

RESULTS

A total of 2,001 dentists (response rate of 39.1%) returned the questionnaires, and information on 9,115 extracted teeth from 7,499 patients was obtained. The results showed that caries and its sequela (totally 43.3%, 32.7% and 10.6%, respectively) and periodontal disease (41.8%) were the main reasons for teeth extraction. Extraction due to caries or fracture was commonly observed in all age groups over 15 years of age, whereas periodontal disease was predominant in the groups over 45 years of age.

CONCLUSIONS

Most of the permanent teeth were extracted due to caries and its sequela and periodontal disease. Prevention and care for dental caries for all age groups and periodontal disease for over middle age groups are required.

Reasons for tooth extraction in four general dental practices in South Wales

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

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.