Predictors of tooth loss over 10 years in adult and elderly Chinese

The Mediating Effects of Nutritional Status on the Relationship between Number of Residual Teeth and Cognitive Function among Older Adults: A Cross-Sectional Multicenter Study

The underlying mechanisms of the relationship between the number of teeth and cognition is still unclear. We aimed to construct a mediation model between the number of residual teeth and cognitive function, using nutritional status as a mediating factor. This study was completed using the West China Health and Aging Trend cohort. A total of 6634 multi-ethnic older adults, aged 50 years or older, were included. This study measured cognitive function using the Short-Portable Mental Status Questionnaire, and nutritional status was assessed using the Mini Nutritional Assessment-Short Form. The mediation analysis examined the potential mediating role of nutritional status. The pathway analysis was supplemented and validated using the structural equation modelling framework. Multiple linear regression demonstrated that a higher number of residual teeth was correlated with enhanced cognitive function (β = -0.15; 95% CI: -0.19 to -0.111). The mediation model, from the number of residual teeth to cognitive impairment, was partially mediated by nutritional status (β = -0.0608; 95% CI: -0.0762 to -0.0461). The proportion of the mediating effect, expressed as a percentage, was 40.66%. Furthermore, the estimated coefficients for the number of residual teeth and nutritional status varied across ethnic groups. This study indicated that enhancing the nutrition of older adults could reduce the adverse effects of the number of residual teeth on cognitive function among older adults.

Comparative Evaluation of Chair-Side Saliva Tests According to Current Dental Status in Adult Patient

Background: this cross-sectional study evaluated the correlation of commercial chair-side saliva tests with caries status in adults. Methods: teeth in 87 adults (20–40 years old) were clinically examined for carious lesions according to International Caries Detection and Assessment System (ICDAS) criteria. The Decayed-Missing-Filling-Tooth (DMFT) and Decayed-Missing-Filling-Surface (DMFS) indexes at D1 (lesions 1–6 according to ICDAS criteria) and D3 (lesions 4–6 according to ICDAS criteria threshold and the number of active lesions, according to the Lesion Activity Assessment (LAA)) criteria were measured. The saliva parameters measured by chair-side tests were stimulated and non-stimulated saliva flow rate, saliva consistency, saliva pH, saliva buffer capacity, and lactic acid production. The statistical analyses performed were Student t-test and Mann–Whitney U test at a = 0.05 significant level. Results: the low resting saliva pH was related to a high value of DMFT (D1) index (p = 0.007). Conclusions: among the saliva parameters measured, the values of low resting pH are associated with increased DMFT at threshold D1. None of the chair-side available saliva tests evaluated can accurately underline the tooth carious status.

Periodontal Diseases as Putative Risk Factors for Head and Neck Cancer: Systematic Review and Meta-Analysis

Whether "periodontal disease" can be considered as an independent risk factor for head and neck cancer (HNC) remains controversial. The aim of the current meta-analysis was to quantitatively assess this relationship in order to determine whether this represents a true risk factor, with implications for cancer prevention and management. PubMed, Scopus, and Embase databases were systematically searched. Selective studies were reviewed, and meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CIs) on eligible studies using a random effects model. In total, 21 eligible observational studies (4 cohorts and 17 case-controls) were identified for qualitative synthesis after a review of 1051 articles. Significant heterogeneity could be identified in measures utilized for reporting of periodontal disease. Meta-analysis performed on nine studies that employed objective measures for reporting periodontal disease demonstrated a significant association between periodontal disease and HNC [OR 3.17, 95% CI, 1.78-5.64]. A diseased periodontium represents an independent risk marker, and a putative risk factor, for HNC. Prospective studies with standardized measures of periodontal disease severity and extent, integrated with microbiological and host susceptibility facets, are needed to elucidate the mechanisms of this positive association and whether treatment of the former influences the incidence and outcomes for HNC.

How to Increase Number of Present Teeth in Elderly: Consideration of Percentile Curves for Present Teeth in Tokyo

Maintaining dental and oral health and increasing healthy life expectancy are important issues for Japan as it deals with the rapid aging of its population. The purpose of this study was to determine effective dental health measures aimed at increasing the number of present teeth in the elderly. Change in the number of present teeth was determined based on data obtained from the 2009 and 2014 "Good Teeth Tokyo (Ii-ha Tokyo)" surveys carried out by the Tokyo Metropolitan Government. The number of present teeth and percentile curves were compared between these two time points. The number only showed a significant increase in individuals aged 60 years in 2014 (p<0.05). This may have been due to the establishment of a national public insurance system. The number of present teeth showed an increase in 2014 in the 25th, 50th, and 75th percentile curves. In the 75th and 90th percentile curves, tooth loss accelerated when the number of present teeth was fewer than 25. This finding is consistent with studies reporting that tooth loss itself is a risk for tooth loss. Tooth loss showed a slight acceleration between the ages of approximately 20 and 45 years in the 90th percentile curve. These results indicate that dental check-ups at universities and companies, periodontal disease check-ups performed by local governments, and health instruction at these check-ups are necessary to increase the number of present teeth in the elderly. They further suggest that implementing measures to promote periodic visits to dental clinics and providing incentives to undergo treatment for tooth defects are necessary in high-risk individuals. In conclusion, dental check-ups, health instruction, and strategies for high-risk individuals in their 20s and 40s are necessary to increase the number of present teeth in the elderly.

Influence of oral health behavior and sociodemographic factors on remaining teeth in Korean adults: 2010-2012 Korea national health and nutrition examination survey

In this study, the number and location of remaining teeth were analyzed according to sociodemographic variables, anthropometric measurements, and oral health behavior patterns. The hypothesis was that the number and location of remaining teeth would be affected by oral health behavior and by sociodemographic factors, such as education levels, household income, and urban/rural residency.This nationwide cross-sectional study was performed with a total of 36,026 representative Korean adults aged 19 and older. The data were taken from the 2012-2012 Korea National Health and Nutrition Examination Survey.Men had, on average, significantly more remaining teeth than women did. Women brushed their teeth more often than men per day and were more likely to brush their teeth after meals. The participants with higher education levels or household income had significantly more remaining teeth; the number of daily tooth brushing was positively associated with the number of remaining teeth; urban residents had significantly more remaining teeth than rural residents; and elderly adults had fewer remaining teeth than younger adults had (all with P < 0.05). The participants were more likely to retain their incisors (especially their canines) for their entire lifetimes than do so for their molars. From the incisors to the second premolars, they had more mandibular teeth than maxillary teeth, but among molars, they had more maxillary teeth than mandibular teeth. Elementary graduates with low household income had fewer remaining teeth than did university graduates with high household income (P < 0.0001). Finally, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.The participants who brushed their teeth fewer times per day, those with low household incomes and/or education levels, and those who lived in rural districts had significantly higher prevalence of tooth loss than did other groups in Korean adults. Participants had more anterior and premolar teeth on mandible, but they had more molars on maxilla. In addition, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.

Socio-Demographic Risk Indicators for Tooth Mortality in Rural Sri Lankans

To explore the socio-demographic factors associated with tooth loss in rural inhabitants of Sri Lanka, a random sample of 2178 males aged 20-60 years was selected using multistage cluster sampling procedure. The number of missing and present teeth was recorded excluding third molars and the subjects were interviewed to elicit socio-demographic information as well as oral hygiene and tobacco consumption habits. The mean number of teeth lost in the sample was 5.17±5.43. Tooth loss increased significantly with age. Sinhalese had significantly fewer lost teeth (5.05±5.38) compared to Tamils (6.54±6.18) and Muslims (6.02±5.21) whereas education, income, oral hygiene practices and tobacco use were significantly associated with tooth loss in the bivariate analysis. A forward stepwise multiple regression analysis revealed that age, Muslim ethnicity and quantified tobacco use were positively associated with tooth loss while better socio-economic conditions and good oral hygiene habits were negatively linked with tooth mortality independent of other factors. Age, Muslim ethnicity, quantified tobacco use, income, education, brushing frequency and substance used for cleaning had significantly affected tooth loss. Quantified tobacco use and oral hygiene may be regarded as modifiable socio-demographic risk indicators associated with tooth mortality in Sri Lankans. Asia Pac J Public Health 2003; 15(2): 105-110.

Tooth loss prevalence and risk indicators in an isolated population of Brazil

OBJECTIVE

The aim of this study was to assess the prevalence, extent, and risk indicators of tooth loss in an isolated population of Brazil.

MATERIAL AND METHODS

Two-hundred-and-forty-two subjects, ranging in age from 14 to 82 years (mean 36.2 years), were identified by census in an isolated population of Brazil. All consenting subjects received a full-mouth clinical (DFT index and information about missing teeth) and periodontal examination of 6 sites per tooth. Furthermore, they were interviewed using a structured written questionnaire in order to gather information about demographic, environmental, and biological variables.

RESULTS

Of the 200 subjects (80% response rate), 19 (9.5%) were edentulous, 90% had lost at least one tooth, and 39% had lost more than 8 teeth. The mean number of teeth lost was 9.5 (95% CI = 8.2-10.8). First mandibular molars were the most commonly missing teeth. In a multiple logistic regression analysis based on a theoretical hierarchical model of tooth loss, having more than 8 teeth lost was strongly associated with adult age (OR = 18.3-17.3, 95% CIs = 4.8-69.7 and 4.0-75.1) and female gender (OR = 5.9, 95% CI = 1.9-18.2) in the final model.

CONCLUSIONS

Tooth loss was highly prevalent and extensive in this isolated population. Demographic and behavioral factors played an important role in tooth loss prevalence in this population.

Risk factors affecting third molar autotransplantation in males: a retrospective survey in dental clinics

The aim of this study was to investigate the risk factors affecting long-term prognosis of autotransplantation of third molars with complete root formation in males at dental clinics. Participating dentists were requested to provide information on transplantations they had undertaken from 1 January 1990 to 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. After data screening and elimination, participants of this study consisted of 183 teeth of 171 males ranging from 20 to 72 years of age (mean age, 44·8 years). The cumulative survival rate was 86·0% at the 5-year mark, 59·1% at 10 years and 28·0% at 15 years. The mean survival time was 134·5 months, as calculated by the Kaplan-Meier method. Single factor analysis using the log-rank test showed that the following factors had significant influence (P < 0·05) on survival of transplanted teeth: periodontal disease as the reason for recipient site tooth extraction, fewer than 25 present teeth and Eichner index Groups B1 to C. Cox regression analysis examined five factors: age, smoking habit, recipient site extraction caused by periodontal disease, fewer than 25 present teeth and Eichner index. This analysis showed that two of these factors were significant: fewer than 25 present teeth was 2·63 (95% CI, 1·03-6·69) and recipient site extraction caused by periodontal disease was 3·80 (95% CI, 1·61-9·01). The results of this study suggest that long-term survival of transplanted teeth in males is influenced not only by oral bacterium but also by occlusal status.

Refining definitions of periodontal disease and caries for prediction models of incident tooth loss

AIM

To assess the suitability of different definitions of caries and periodontitis for inclusion in tooth loss prediction models.

MATERIALS AND METHODS

The Study of Health in Pomerania (SHIP) is a population-based cohort study conducted in 1997-2001 (SHIP-0) and 2002-2006 (SHIP-1). This sample comprised 2,780 subjects aged 20-81 years with complete information on dental and periodontal status [DMFS status, clinical attachment loss (CAL) and probing depth (PD)]. Analyses on five-year tooth loss were limited to half-mouth data.

RESULTS

The predictive value of tested definitions was markedly age- and gender-dependent: in 20-39-aged men, the number of decayed or filled surfaces best predicted the number of lost teeth, whereas in young women CAL≥4 mm performed best. In older subjects, periodontal definitions were superior to caries definitions: mean CAL performed best in 40-59-year olds, whereas AL- or PD-related definitions predicted best in 60-81-year olds. On tooth level, mean CAL was the superior definition to assess 5-year incident tooth loss in all strata except for young men.

CONCLUSIONS

Caries parameters best predicted incident tooth loss in men aged 20-39 years; in the intermediate and oldest age group and in young women, mean AL was most informative. Therefore, prediction models need to be developed for different age and gender groups.

Antimicrobial Activity of Few Medicinal Plants against Clinically Isolated Human Cariogenic Pathogens-An In Vitro Study

Hexane, ethyl acetate, ethanol and methanol extracts of Psidium guajava, Terminalia chebula, Mimusops elengi and Achyranthes aspera were tested against the dental caries causing bacteria Streptococcus mutans and fungus Candida albicans isolated from caries infected patients. All the four extracts of P. guajava showed activity against both S. mutans and C. albicans. Maximum zone of inhibition was observed in ethyl acetate of P. guajava. The four extracts of T. chebula and M. elengi showed antibacterial activity against S. mutans. M. elengi extracts and ethanol extract of T. chebula did not show any antifungal activity against C. albicans. Except for the hexane extract of A. aspera, the other three extracts showed activity against the tested microbes. The ethyl acetate P. guajava leaf extract showed the minimum inhibitory concentration (MIC) against S. mutans to be <0.076 mg/mL in both MHB and BHI. The P. guajava ethyl acetate extract was subjected to GC-MS.

Patterns of tooth loss in older adults with and without dementia: a retrospective study based on a Minnesota cohort

OBJECTIVES

To study tooth loss patterns in older adults with dementia.

DESIGN

Retrospective longitudinal study.

SETTING

A community-based geriatric dental clinic in Minnesota.

PARTICIPANTS

Four hundred ninety-one older adults who presented to the study clinic as new patients during the study period, remained dentate after finishing the initial treatment plan, and returned for care at least once thereafter were retrospectively selected. One hundred nineteen elderly people with International Classification of Diseases, Ninth Revision, codes 290.x, 294.1, or 331.2 or a plain-text diagnosis of dementia, Alzheimer's disease, or chronic brain syndrome in the medical history were considered having dementia.

INTERVENTION

All existing dental conditions were treated before enrollment. Dental treatment was continually provided for all participants during follow-up.

MEASUREMENTS

Tooth loss patterns, including time to first tooth loss, number of tooth loss events, and number of teeth lost per patient-year were estimated and compared for participants with and without dementia using Cox, Poisson, and negative-binomial regressions.

RESULTS

Participants with dementia arrived with an average of 18 and those without dementia with an average of 20 teeth; 27% of remaining teeth in the group with dementia were decayed or retained roots, higher than in the group without dementia (P<.001). Patterns of tooth loss did not significantly differ between the two groups; 11% of participants in both groups had lost teeth by 12 months of follow-up. By 48 months, 31% of participants without dementia and 37% of participants with dementia had lost at least one tooth (P=.50). On average, 15% of participants in both groups lost at least one tooth each year. Mean numbers of teeth lost in 5 years were 1.21 for participants with dementia and 1.01 for participants without dementia (P=.89).

CONCLUSION

Based on data available in a community-based geriatric dental clinic, dementia was not associated with tooth loss. Although their oral health was poor at arrival, participants with dementia maintained their dentition as well as participants without dementia when dental treatment was provided.

Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

 

OBJECTIVE

While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss.

METHODS

Postmenopausal women (N = 1341) were recruited between 1997 and 2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women's Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002-2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination.

RESULTS

After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR = 1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR = 1.13 per mm loss, 95% CI 1.05, 1.23), and pocket depth (PD) (OR = 1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR = 2.45, 95% CI 1.26, 4.77), prior gum disease (OR = 1.97, 95% CI 1.43, 2.70), ever smoking (OR = 1.42, 95% CI 1.06, 1.89), number of teeth lost at baseline (OR = 1.05 per tooth, 95% CI 1.02, 1.08), and BMI (OR = 1.15 per 5 km/m(2) increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss.

CONCLUSIONS

Clinical and questionnaire-based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high-risk postmenopausal women where preventive strategies may be targeted.

Life-course Determinants of Need for Dental Prostheses at Age 24

This study aimed to assess the prevalence of use and need for dental prostheses (UNDP) by individuals at age 24 and their life-course determinants. A representative sample (n = 720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and the UNDP were assessed in 2006. Exploratory variables included demographic and socio-economic, oral health, and dental service utilization patterns during the life-course. The prevalence of UNDP was 2.1% and 29.7%, respectively. Multivariable Poisson regression analysis showed that low socio-economic status through the life-course [Prevalence Ratio (PR) = 1.56 (95% CI: 1.08-2.26)], lower maternal schooling in childhood [PR 2.79 (1.34-5.79)], no oral hygiene instruction by a dentist at age 15 [PR 1.64 (1.11-2.41)], and caries presence at age 15 (high DMFT tertile) [PR 2.90 (1.98-4.24)] were associated with prosthetic treatment needs. These results support the hypothesis that life-course socio-economic, behavioral, and clinical determinants are associated with the need for dental prostheses.

Social inequality in tooth extraction in a Brazilian insured working population

OBJECTIVES

Given the scant evidence of the socioeconomic gradient in tooth loss incidence, the purpose of this study was to compare the odds of individuals of distinct social strata being subjected to tooth extraction.

METHODS

We undertook a case-control study at the head office of a large Brazilian company whose employees had access to dental care through the company's dental insurance.

RESULTS

During 2 years of observation, 264 teeth were extracted and the distribution of such extractions was rather unequal. A strong suggestion of a social gradient was noted and the odds of tooth extraction occurring per social strata, adjusted by age and gender, were five times higher in employees pertaining to the lowest social stratum, when compared with those at the highest.

CONCLUSIONS

We concluded that lower social strata were strongly associated with increased risk of having teeth extracted. Dental insurance was not able to equalize the chances of tooth extraction among different social strata, in a population of employed adults.

Tooth loss in treated periodontitis patients responsible for their supportive care arrangements

AIM

To identify risk indicators associated with tooth loss and periodontitis in treated patients responsible for arranging supportive periodontal care (SPC).

MATERIALS AND METHODS

Ninety-seven Chinese subjects (34-77 years) who showed favourable responses to periodontal therapy provided in a teaching hospital 5-12 years previously were recalled. They were advised to seek regular SPC on discharge. Background information, general health status, smoking, oral hygiene habits, follow-up dental care, tooth loss, and periodontal parameters were investigated. Multiple regression analysis was performed.

RESULTS

Two hundred and fifty-six teeth had been lost, 195 because of self-reported periodontal reasons. Up to 26.8% sites were with pockets > or =6 mm. Positive correlations were found between total/periodontal tooth loss and (i) smoking pack-years, (ii) time spent on oral hygiene, (iii) years since therapy's conclusion, (iv) age, and negative correlations with (v) inter-dental brush use, and (vi) education levels. Tooth loss by arch was correlated with wearing of removable partial denture in that arch. Percentage sites with pockets > or =6 mm were significantly negatively correlated with percentage sites without bleeding on probing.

CONCLUSIONS

Smokers, more elderly patients, removable partial denture wearers, and patients with lower education levels or not using inter-dental brushes ought to be targeted for clinic-based SPC.

Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals

OBJECTIVE

To determine tooth loss, wearing of dentures and associated factors in older individuals from Sri Lanka.

DESIGN

A cross-sectional survey where the data were collected by means of an oral examination and an interviewer administered questionnaire.

SETTING

Negambo within the Gampaha district of Sri Lanka.

SUBJECTS

A total of 630 subjects who were aged 60 years and above.

RESULTS

Only 11 subjects had all 32 teeth and 17% were edentulous. Age, gender and level of income were significantly associated with the number of missing teeth. Of those with missing teeth, 22% wore dentures. Only 16% of the non-denture wearers perceived a need for dentures. Among the non-denture wearers who perceived a need for dentures, a majority had cited 'cost' as the main barrier for obtaining dentures. Logistic regression analysis revealed that age, gender, levels of income and education and missing teeth were significant predictors of wearing of dentures.

CONCLUSIONS

Knowledge of factors that influence tooth loss and wearing of dentures may have implications for oral health care planners in the provision and delivery of oral health services to the older individuals.

The natural history of periodontal disease in humans: risk factors for tooth loss in caries-free subjects receiving no oral health care

AIM

No long-term studies have reported on risk factors for tooth loss in subjects without home or professional dental care. The purpose of this report is to identify potential risk factors for tooth loss among male Sri Lankan tea labourers who participated in a 20-year investigation of the natural history of periodontal disease.

MATERIAL AND METHODS

Data for this report were obtained from the 455 subjects who participated in multiple examinations over the 20-year period from 1970 to 1990. Analyses included data from interim examinations in 1971, 1973, 1977, 1982 and 1985. Oral health assessments included the following: (1) attachment levels in millimetres on all mesial and mesio-buccal surfaces, excluding third molars; (2) plaque index; (3) gingival index; (4) calculus index; (5) caries index; and (6) missing teeth. Other variables included age, history of smoking and betel nut use. Statistical analyses included descriptive statistics and multivariate repeated-measures modelling with generalized estimating equations.

RESULTS

Tooth loss was significantly dependent upon interactions between the mean attachment loss and betel nut use (Z=3.40; p=0.0007) and history of missing teeth (Z=-3.70; p=0.0002). The effect of attachment loss on tooth loss was increased in the presence of betel nut and diminished when teeth were already missing at baseline.

CONCLUSION

History of missing teeth, betel nut use and increasing attachment loss were significant predictors of tooth loss over time. Betel nut use increased the effect of attachment loss on loss of teeth, while history of missing teeth diminished the effect of attachment loss on tooth loss.

Oral health knowledge, attitudes and behaviour of adults in China

OBJECTIVES

To describe oral health behaviour, illness behaviour, oral health knowledge and attitudes among 35-44 and 65-74-year-old Chinese; to analyse the oral health behaviour profile of the two age groups in relation to province and urbanisation, and to assess the relative effect of socio-behavioural risk factors on dental caries experience.

METHODS

A total number of 4,398 35-44-year-olds and 4,399 65-74-year-olds were selected by multistage stratified cluster random sampling which involved 11 provinces in China. Data were collected by self-administered structured questionnaires and clinical examinations (WHO criteria).

RESULTS

32% of the 35-44-year-olds and 23% of the 65-74-year-olds brushed at least twice a day but only 5% used fluoridated toothpaste; 30% and 17% respectively performed 'Love-Teeth-Day' recommended methods of tooth brushing. A dental visit within the previous 12 months was reported by 25% of all participants and 6% had a dental check-up during the past two years. Nearly 15% of the subjects would visit a dentist if they experienced bleeding from gums; about 60% of the subjects paid no attention to signs of caries if there was no pain. Two thirds of the urban residents and one fifth of the rural participants had economic support for their dental treatment from a third party, either totally or partially. Significant variations in oral health practices were found according to urbanisation and province. At age 35-44 years 43% of participants had daily consumption of sweets against 28% at age 65-74 years. Dental caries experience was affected by urbanisation, gender, frequency, time spent on and method of tooth brushing. Knowledge of causes and prevention of dental diseases was low with somewhat negative attitudes to prevention observed.

CONCLUSION

Systematic community-based oral health promotion should be strengthened and preventive-oriented oral health care systems are needed, including promotion of further self-care practices and the use of fluoridated toothpaste.

Predictors of Tooth Loss in Two US Adult Populations

OBJECTIVES

This study determines tooth loss rate over a 10-year period and identifies predictors of tooth loss in two separate US adult longitudinal study populations.

METHODS

Subjects from the Baltimore Longitudinal Study of Aging (BLSA), consisting of 47 men and 47 women, ages ranging from 30 to 69 years, were compared to subjects from the VA Dental Longitudinal Study (VADLS) in Boston, MA, consisting of 481 men in the same age range. Baseline and follow-up examinations were performed on each cohort over a 10-year period. Using multivariate regression models, significant predictors of tooth loss were identified.

RESULTS

A mean rate of tooth loss of 1.5 teeth lost per 10 years was noted in the VADLS cohort compared to 0.6 teeth lost per 10 years in the BLSA (P < .001). Combining subjects from both populations, significant predictors of tooth loss were baseline values of: percent of teeth with restorations, mean probing pocket depth score, age, tobacco use, alcohol consumption, number of teeth present, and male sex. However, the set of significant predictor variables differed between the two populations and sexes. In BLSA men, number of teeth present, percent of teeth with restorations, mean probing pocket depth score, and alcohol consumption, but not age, were significant, while in BLSA women, only age was a significant predictor.

CONCLUSIONS

Over a 10-year period, the incidence of tooth loss, the rates of tooth loss, and the predictors of tooth loss were found to vary by population and by sex. These results illustrate the limits of generalizing tooth loss findings across different study cohorts and indicate that there may exist important differences in risk factors for tooth loss among US adult populations.

Multilocus sequence analysis of Porphyromonas gingivalis indicates frequent recombination

In this study, the genetic relationship of 19 Porphyromonas gingivalis isolates from patients with periodontitis was investigated by multilocus sequence analysis. Internal 400-600 bp DNA fragments of the 10 chromosomal genes ef-tu, ftsQ, hagB, gpdxJ, pepO, mcmA, dnaK, recA, pga and nah were amplified by PCR and sequenced. No two isolates were identical at all 10 loci. Phylogenetic analyses indicated a panmictic population structure of P. gingivalis. Split decomposition analysis, calculation of homoplasy ratios and analyses of clustered polymorphisms all indicate that recombination plays a major role in creating the genetic heterogeneity of P. gingivalis. A standardized index of association of 0.0898 indicates that the P. gingivalis genes analysed are close to linkage equilibrium.

Tooth loss in the very old: 13-15-year incidence among elderly Iowans

OBJECTIVES

Very few studies have reported tooth loss incidence over a period of 10 years or more, and fewer have reported tooth loss occurrence in subjects aged 80 and older, so that the long-term pattern of tooth loss in the very old is largely unknown. This study assessed 13-15-year tooth loss incidence among a cohort of Iowans, aged 65 and older at baseline.

METHODS

Oral examinations were conducted on 520 subjects beginning in 1983, and periodically until 1988, with another round of examinations conducted on surviving members of the initial cohort during 1996-98.

RESULTS

Of the 73 remaining subjects, 45 subjects lost a total of 153 teeth during the period (mean=2.1 teeth lost), with a maximum of 17 teeth lost. Molars were the most commonly lost teeth, while canines and maxillary incisors were the least commonly lost. Bivariate analyses found that tooth loss was associated with untreated decay at baseline and level of periodontal attachment loss at earlier examinations. Logistic regression identified only greater severity of attachment loss as a significant risk factor for tooth loss (Adjusted odds ratio=2.4, P=0.006). The impact of tooth loss on subjects' lives was assessed using OHIP and other questions. The occurrence of tooth loss over the study period had little impact, but the number of remaining teeth significantly impacted subjects' ability to eat or chew food, swallow, or their willingness to smile.

CONCLUSIONS

These results suggest that tooth loss continues in the very old, that periodontal attachment loss is associated with tooth loss in this age group, and that loss of teeth over one's lifetime does affect certain quality-of-life measures.

Extraction of teeth over 5 years in regularly attending adults

OBJECTIVES

This prospective study was conducted to describe the incidence of tooth extraction in a group of regularly attending adults and to assess factors that are predictive of tooth loss.

METHODS

Baseline and annual incremental clinical data were obtained from 23 general dental practitioners on a group of their regularly attending, dentate adult patients over a 5-year period. The patients completed a postal questionnaire with questions relating to dental health behaviours, attitudes and knowledge, and social factors.

RESULTS

Complete clinical data were obtained from 2799 patients. Four hundred and seventy (17%) patients underwent extractions, 72% of which were posterior teeth. The majority of extractions were for reasons other than caries (79%). Bivariate analyses revealed many significant differences between patients who underwent extractions and those who did not, with respect to the clinical, social, behavioural and attitudinal variables. The logistic regression model for tooth loss included three clinical variables, number of teeth, crowns and sites with recession. Other variables in the final model included the dentist's and patient's prediction of treatment need, having sensitive teeth, having a sweet tooth, living alone and smoking. The sensitivity for the model was 0.57 with specificity 0.72.

CONCLUSIONS

This study is unique in its examination of patients and has highlighted that both clinical and other factors are important in predicting who will undergo extractions. Future investigations should assess the consequence of having extractions in terms of health benefit or detriment.

Forty-five-year tooth survival probabilities among men in Oslo, Norway

Changes in tooth survival probabilities over a person's lifetime have remained largely unexplored. The goal of this study was to evaluate changes in the 45-year tooth survival probabilities in a cohort of 565 Norwegian males who were examined in 1969 as young adults, and followed up into mid-life (examination years and sample sizes (n): 1971 (n = 381), 1973 (n = 292), 1975 (n = 245), 1981 (n = 228), 1988 (n = 202), and 1995 (n = 223). The results indicated that the tooth survival probabilities varied considerably both (i) among teeth within individuals, and (ii) over time. The 45-year survival probabilities for the 28 teeth fell into the following ranges: larger than 95% for incisors and cuspids; between 84% and 92% for premolars; and between 59% and 96% for molars. Over the first 4 post-eruptive decades, the tooth mortality risks (excluding orthodontic extractions) were: 1st decade, 2.0% (from 1.7 to 2.4%); 2nd decade, 0.2% (from 0.1 to 0.4%); 3rd decade, 0.6% (from 0.4 to 0.8%); and 4th decade, 1.1% (from 0.8 to 1.5%). The tooth mortality risks in the 2nd, 3rd, and 4th decades were probably somewhat underestimated (due to dropout bias), suggesting that the true underlying tooth mortality hazard function may have been V-shaped. The conclusions were that the tooth mortality hazard during the first 4 post-eruptive decades was bathtub-shaped and that it varied considerably among teeth within individuals.

The periodontal disease problem. A comparison between industrialised and developing countries

There is no reason to believe that periodontal diseases in industrialised and developing countries are in principle different. That is, not in the sense that the problem is caused by a different set of periodontal diseases, with different micro-organisms and a different natural history, needing a different approach towards prevention and treatment. Indeed, from a public health perspective the relative similarities in periodontal conditions around the world are far more striking than the differences. The view that periodontal diseases are a much more prevalent and a severe problem in the developing countries seems to be true only in terms of poorer oral hygiene and considerably greater calculus retention, already at a young age, but not so clear for periodontal destruction in adults.

Predictors of destructive periodontal disease incidence and progression in adult and elderly Chinese

This study describes some predictors of new and progressing destructive periodontal disease over a 10-year period in rural Chinese. A total of 398 persons aged 20-80 years, who had participated in a baseline survey of tooth mortality, dental caries and periodontal conditions and were still dentate 10 years later, were reexamined for the same parameters as assessed at baseline. Three different threshold values were used to define new and progressing destructive periodontal disease. Irrespective of the threshold used, most persons experienced new disease. Progressing disease was very prevalent when a 2+ mm disease definition was used, but occurred less frequently at the higher threshold levels. The logistic regression models for 2+ and 3+ mm disease were essentially similar, and showed that women, persons with 104 sites or more, and persons with 0-5% sites with 4+ mm attachment levels had a lower risk of disease progression as well as of new disease than did men, persons with few sites and persons with 6% sites or more with attachment levels 4+ mm. The variables sex, number of sites present, percentage of sites with 4+ mm attachment levels, and presence of mobile teeth were predictive for new disease using a 4+ mm definition. Age, percentage of sites with 4+ mm attachment levels and percentage of sites with 4+ mm pockets were predictive for progressing disease using the 4+ mm disease definition.