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

Oral health indicators and bone mineral density disorders in older age: A systematic review

As we age, maintaining good oral health becomes increasingly crucial for performing daily tasks. Age-related physiological decline can disrupt various biological systems, causing a significant challenge for geriatric dentistry. A systematic review of the literature using six different electronic databases was conducted to investigate the relationship between oral health indicators and bone mineral density disorders in older adults. The study is registered as a priori protocol on PROSPERO (CRD42023403340). A minimum age of 60 years was the main inclusion criterion for all original research articles. Two independent researchers assessed the eligibility of 19,362 records against the inclusion criteria and found 12 articles fitting the eligibility requirements. Five different indicators of poor oral health [number of teeth, periodontal disease, general oral health (dental caries prevalence and dental treatment needs), masticatory function, and occlusal force)] were found related to three outcomes linked to bone mineral density disorders (osteoporosis, fractures, and decreased bone mineral density), regardless of the adopted assessment tools. The number of teeth was negatively associated with fractures and a decreased bone mineral density, while periodontal disease was positively associated with osteoporosis and a decreased bone mineral density. Masticatory function was associated only with osteoporosis, while general oral health was associated only with fractures and occlusal force only with bone mineral density. The oral health indicator most frequently associated with outcomes linked to bone mineral density disorders was the number of teeth. The present findings could help to assess the contribution of each oral health indicator to the development of bone mineral density disorders in older age.

Edentulism among diabetic patients compared to non-diabetic controls: A systematic review and meta-analysis

OBJECTIVE

The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non-diabetic people.

METHODS

MEDLINE-PubMed and Cochrane-CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta-analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach.

RESULTS

Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta-analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non-diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non-diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001).

CONCLUSION

There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non-diabetic people is significant, but the odds ratio is estimated to be small.

Association between tooth loss and hypertension: A systematic review and meta-analysis

OBJECTIVES

Poor oral health status may increase the risk of cardiovascular disease. However, whether a specific association exists between tooth loss and hypertension is inconclusive. Accordingly, a quantitative systematic review was conducted to investigate the relationship between tooth loss and hypertension.

METHODS

Systematic search, data analysis and quality assessment were conducted on relevant literature published in PubMed, Embase, Web of Science and Cochrane Libraries until October 2021. Odds ratio (OR) with 95% confidence interval (CI) was used as effect size to evaluate the association between tooth loss and hypertension. Meta-regression and subgroup analyses were performed to identify whether difference was associated with study-level factors.

RESULTS

Of the 56 studies selected, 28 studies in 16 different countries involving 1,224,821 individuals were eligible for the systematic review. After adjustment for confounding factors, individuals with tooth loss had a higher risk for hypertension (OR 1.20; 95%CI 1.10-1.30, I² = 40.02%). With respect to the risk of hypertension on tooth loss, individuals with hypertension still had a higher risk for tooth loss (OR 1.35; 95%CI 1.07-1.62, I² = 51.10%). Age limitation of the included population is the major source of heterogeneity. However, studies in which the population was limited to the elderly did not report an increase in association between tooth loss and hypertension compared with studies without age limitation.

CONCLUSIONS

The results suggest a bidirectional association between tooth loss and hypertension. Future longitudinal prospective studies are required to establish causality between tooth loss and hypertension.

CLINICAL SIGNIFICANCE

Subjects with severe tooth loss should be carefully monitored for the manifestation of hypertension. The oral health status of hypertensive patients should also be meticulous maintained to prevent unwarranted tooth loss.

Association between asthma and severe tooth loss in the adult population of the United States

OBJECTIVE

This study aimed to investigate the association between asthma and severe tooth loss in the U.S. (United States) adult population.

METHODS

Data were analyzed from the national health and nutritional examination survey (NHANES), 2009-2014. Study-participants were classified into current, former, and never asthmatics based on their asthma status. Former-asthmatics were excluded. The case definition of severe tooth loss (outcome variable) was having 9 or fewer remaining permanent teeth. Characteristics of our study-sample were identified based on the descriptive statistical analyses. Logistic regression analyses were performed to examine the association between asthma and severe tooth. Multivariable models were constructed to control for the known common clinical, demographic, and lifestyle factors. Each analysis accounted for the examination sample weights and the complex clustered design of the continuous NHANES.

RESULTS

Total study-participants were 14,184 representing ≈185.77 million U.S. adults. Prevalence of asthma was 8.99% in our study-sample, and 8.78% had severe tooth loss. Current-asthmatic adults had 34% higher odds of severe tooth loss as compared to their reference group of never-asthmatics adults in the U.S. after controlling for age, race or ethnicity, gender, diabetes, smoking, body mass index, education, and family income-to-poverty ratio.

CONCLUSION

In the United States, as compared to never-asthmatic adults, current-asthmatic adults were more likely to have severe tooth-loss. Oral health promotion is therefore recommended through medical-dental integration to ensure overall health for asthmatic adults.

Relationship between hypothyroidism and periodontitis: A scoping review

AIM

The objective of this study was to assess the existing literature to determine if a relationship exists between hypothyroidism and periodontitis.

METHODS

We used a modified approach to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses by searching five databases in addition to the gray literature. Keywords in the title and abstract fields, as well as subject headings for both periodontal disease and hypothyroidism, were used to search the existing literature for publications relevant to evaluation of the thyroid-periodontitis relationship.

RESULTS

The authors screened 847 unique publications which, after applying inclusion and exclusion criteria, yielded 29 publications, which were further analyzed for relevance and applicability. Most of the included papers were cross-sectional studies and retrospective chart reviews. Following critical analysis, four publications, including one abstract, were used to further assess the hypothyroid-periodontitis relationship.

CONCLUSIONS

There are very few high-quality studies describing the potential association between hypothyroidism and periodontitis. In general, and among the included papers with the fewest confounding factors, a positive relationship between hypothyroidism and periodontitis was found. Further well-controlled, prospective clinical and immunologic studies will be required to confirm that relationship.

Asthma, chronic obstructive pulmonary disease, tooth loss, and edentulism among adults in the United States: 2016 Behavioral Risk Factor Surveillance System survey

BACKGROUND

Adults with chronic respiratory conditions, specifically asthma or chronic obstructive pulmonary disease (COPD), may be at risk of experiencing poor oral health due to systemic inflammation, challenges in routine oral health care, and adverse effects of medications used to treat these conditions. The authors examined the association of asthma, COPD, and coexisting asthma and COPD (asthma-COPD overlap syndrome [ACOS]) with tooth loss among US adults.

METHODS

The authors conducted a cross-sectional study using 2016 Behavioral Risk Factor Surveillance System data (N = 387,217). The authors categorized the participants with missing permanent teeth into 4 groups: asthma only (n = 38,817), COPD only (n = 19,819), ACOS (n = 13,494), no asthma, no COPD (n = 315,087). The authors used adjusted multinomial logistic regressions to examine the associations between asthma and COPD categories and tooth loss.

RESULTS

According to the authors, 5.3% of study participants reported they were edentulous; 10.7% reported 6 or fewer missing teeth. Participants with asthma only, COPD only, and ACOS had higher odds of reporting tooth loss (6 or more teeth) than those in the no asthma, no COPD group; adjusted odds ratios were 1.12 (95% confidence interval, 1.00 to 1.26) to 2.04 (95% confidence interval, 1.85 to 2.26). A lower percentage of participants with COPD and ACOS visited dentists in the past year than those with no asthma and no COPD. Interactive associations suggested participants with asthma or COPD with dental visits were less likely to report edentulism than those with neither asthma nor COPD and no dental visits.

CONCLUSIONS

Participants with asthma or COPD had higher odds of tooth loss compared with those with neither asthma nor COPD.

PRACTICAL IMPLICATIONS

People with asthma or COPD should maintain routine dental visits to reduce the risk of experiencing tooth loss.

Dental status as a predictor of mortality among nursing facility residents in eastern Iowa

OBJECTIVE

This study aimed to evaluate dental status (ie, number of teeth and presence of removable dental prostheses) as a predictor of all-cause mortality among nursing facility residents.

BACKGROUND

Edentulism has been associated with poorer health outcomes in geriatric populations.

MATERIALS AND METHODS

Between March 2006 and June 2008, oral health screening examinations were completed for 584 residents of 10 nursing facilities in four eastern Iowa counties. In September 2013, demographic, general and oral health information was obtained from the screening forms and linked with Iowa state death certificate data. The study outcome (time to death) was defined as the number of days between the screening examination and death. Univariate and bivariate distributions were assessed, and multivariable Cox proportional hazards regression models were generated to arrive at factors associated with time to death.

RESULTS

A total of 535 residents were eligible for data analysis. Age at screening ranged from 60-103 years (mean=85.2), 70% were female, and 33% were edentulous. By September 2013, 468 (87.5%) had died, with a median time to death among these individuals of 2.0 years. The final multivariable Cox model included data from 393 (73.4%) of the residents; statistically significant relationships were observed between time to death and dental status, age, sex, cooperativeness with care providers and renal disease.

CONCLUSIONS

Dental status remained strongly associated with time to death even after controlling for other important demographic and health-related factors.

Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China

OBJECTIVE

To investigate the prevalence of self-reported edentulism and its associated risk factors among community-dwelling adults aged 45 years and older in China.

MATERIALS AND METHODS

Data from the national baseline survey (2011-2012) of the China Health and Retirement Longitudinal Study (CHARLS) were used for this study (N = 17 167). Bivariate and multivariate logistic regressions were conducted to assess the predictors of edentulism. Models 1 and 2 were based on the whole sample. Models 3 and 4 were based on the subsample (N = 9933) from whom anthropometric and blood biomarker data were available.

RESULTS

The prevalence of edentulism was 8.64% among Chinese adults aged 45 and above. As shown by Model 1, older age was a robust predictor for edentulism (odds ratio [OR] = 3.81 for people aged 55-64; OR = 11.22 for people aged 65-74; OR = 24.05 for people aged 75 and above). Other factors positively associated with edentulism included being female (OR = 1.25), rural residence (OR = 1.30), asthma (OR = 1.48), depression (OR = 1.20), reduced physical function (OR = 1.37) and current smoking status (OR = 1.36). People with higher educational levels (OR = 0.75 for people who can read and write; OR = 0.64 for people who obtained a junior high school education or above) and better-off economic status (OR = 0.80) were less likely to be edentate. The association between edentulism and age, educational level, economic status and physical function remained significant in Model 3, and in addition, being underweight appeared as another strong predictor (OR = 1.93).

CONCLUSIONS

The estimated prevalence of edentulism and the identified associated factors will provide epidemiologic evidence for future research and interventions in the target population in China.

Shortcomings of prosthodontic rehabilitation of patients living in long-term care facilities

Removable dentures are a non-invasive, cost-effective prosthodontic solution for the reduced dentition. Their intended purpose is the rehabilitation of harmonious oral function and aesthetics on a long-term basis. The prevalence of removable dentures among patients of advanced age is high and the quality of the dentures is often poor. The aim of this study was to find the most important shortcomings of removable dentures and address the main targets for improving the quality of prosthodontic rehabilitation. The records from dental check-ups in Austrian residential homes were analysed retrospectively. Dental anamnesis questionnaires and data from the clinical examinations of 105 denture wearers were analysed. The functional condition and retention of 192 dentures had been assessed, as well as the impact of the dentures on the intra-oral tissues. Insufficient denture retention was very common, particularly in the lower jaw (56·0%). Problems with the masticatory function were reported by 26.7% of the denture wearers, 11·4% were dissatisfied with the denture aesthetics, and 4·8% had difficulties with phonetics. Traumatic ulcers were found in 18·1%. Cracks, broken pieces (6·3%) or missing denture teeth (2·1%) were rare. It may be assumed that the findings of the present study also apply to a great percentage of community-dwelling seniors. The most important issues in prosthodontic rehabilitation with removable dentures are denture retention and masticatory function. Regular dental check-ups, denture adjustment and, when necessary, relining can maintain the primary denture quality and prevent damages of the oral tissues caused by ill-fitting dentures.

Complete Edentulism and Comorbid Diseases: An Update

The relationship between complete edentulism, which is the terminal outcome of a multifactorial oral disease process and other comorbid diseases, was first reported in 2009. Although the relationship between edentulism and a multitude of systemic diseases was reported, none of the publications studied could determine causality of tooth loss on the incidence of any comorbid disease. Since that publication, there has been a renewed interest in this relationship, and a plethora of new articles have been published. This article will provide an update on articles published since 2008 on the relationship between edentulism and comorbid diseases, and will include the relationship between complete edentulism and such comorbid conditions as malnutrition, obesity, cardiovascular disease, rheumatoid arthritis, pulmonary diseases (including chronic obstructive pulmonary disease), cancer, and even mortality.

Interrami intraoral fixation technique utilized as a conservative approach to edentulous/atrophic mandibular fractures

Interrami intraoral Kirschner wire fixation (IRIF) technique is presented as new conservative successful indirect rigid fixation utilized for the reduction and fixation of edentulous/atrophic mandible fractures. This technique is carried out under local anesthesia without the need for open reduction internal fixation, which can lead to a compromise in the blood supply of fracture region. It is also quicker, easier, requires fewer postoperative visits, and cheaper than small or large bone plate fixations.Five edentulous mandibular fractures, 2 of them atrophic, 2 non-atrophic, and 1 partial edentulous, were successfully treated. In all cases, the IRIF technique was utilized to establish an indirect rigid fixation using horseshoe-shaped Kirschner wire with a 2-mm diameter. No complication was reported during these cases. This technique prevails over the Gunning splint and external edentulous fracture fixation techniques as it provides adequate fracture site stability, is more comfortable, and is better tolerated for a longer period of time by the patient. In addition, there are fewer complications caused by malunions from direct intraoral or extraoral small and large plate fixation techniques. Other advantages of the IRIF technique are that it enables the mandible to function as a single unit and preserves its function and anatomical position immediately after surgery. In contrast, the Gunning splint acts only to preserve the balance of a single segment's position.

Prevalence of Dentulism, Partial Edentulism and Complete Edentulism in Rural and Urban Population of Malwa Region of India: A Population-based Study

Background

The objective of this study was to evaluate the prevalence of dentulism, partial edentulism and complete edentulism in rural and urban population of Malwa region of India, who visited at department of prosthodontics for the first time.

Materials and methods

An institution-based, cross-sectional study using the random sampling method was used to select the study sample of 1000 males and females. Data were collected using questionnaires and oral examination. Data were statistically analyzed using Chi-square test.

Results

Nearly, 38.5 and 63.1% of the rural and urban females were dentulous in the age of below 53 and 43 years. 61.4 and 36% of rural and urban males were dentulous in the age of below 53 and 43 years. Nearly, 41.9 and 48.2% of the rural and urban females were partial edentulous in the age of above 53 and 43 years. Fifty-eight and 51.7% of rural and urban males were dentulous in the age of above 53 and 43 years. Nearly, 22.4 and 55.8% of the rural and urban females were completing edentulous in the age of above 43 years in both population. 77.5 and 44.1% of rural and urban males were completing edentulous in the age of above 33 and 53 years.

Limitation

The study was conducted in an institution-based set-up. Hence, any interpretation of the results of this study must bear this limitation in mind.

Conclusion

It is essential to identify feasible strategies to provide primary dental health education and treatment to all rural and urban elderly in the future. We suggest community dental health services to be included in general health of the elderly rather than a special health need of the community.

How to cite this article

Sonkesariya S, Jain D, Shakya P, Agrawal R, Prasad SVS. Prevalence of Dentulism, Partial Edentulism and Complete Edentulism in Rural and Urban Popu- lation of Malwa Region of India: A Population-based Study. Int J Prosthodont Restor Dent 2014;4(4):112-119.

Impact of osteoporosis and its treatment on oral health

Osteoporosis has emerged as a major health problem affecting middle-aged and older individuals. It is characterized by a reduced bone mass and strength, resulting in increased susceptibility to fractures. The disease is associated with several risk factors, and increasing evidence suggests that it may be associated with oral health conditions such as periodontal disease, reduced jaw bone density and tooth loss. Besides the effects of osteoporosis on oral health, bisphosphonate-related osteonecrosis of the jaws is a major concern to the dentist. Bisphosphonate-related osteonecrosis of the jaws is a recently described adverse effect of bisphosphonate therapy. The exact mechanisms by which these drugs cause necrosis of the jaws remain unclear, and a true cause-and-effect relationship between osteonecrosis of the jaw and bisphosphonate use has not yet been established. Hence, any form of invasive dentoalveolar treatment should be performed with caution in patients taking bisphosphonates. This review discusses current evidence on osteoporosis and its treatment implications as a risk factor in the development of various oral diseases.

Osteoporosis, fragility fracture, and periodontal disease: a cross-sectional study in Spanish postmenopausal women

OBJECTIVE

Osteoporosis and periodontitis are common disorders that affect aging populations. It has been hypothesized that both conditions may be related. The aim of this study was to evaluate the relationship between osteoporosis and periodontitis using vertebral fragility fracture as a real marker of osteoporosis and periodontal clinical examination to define periodontitis.

METHODS

Six hundred thirty-four women aged 55 to 70 years, with fragility spine fractures, and living in the same healthcare region of Seville, Spain, were invited to take part in this cross-sectional study conducted from 2008 to 2010. All the women included in the study were referred to undergo spine radiological examination, spinal densitometry, and full-mouth periodontal assessment.

RESULTS

With the exception of number of teeth (19 in the fractured postmenopausal group and 23 in the control group; P < 0.007) and sites with a clinical attachment level lower than 7 mm (P < 0.048), there were no significant differences in clinical and periodontal parameters among women in the fractured postmenopausal group and the control group. In short, fractured postmenopausal women have lost more teeth with more advanced attachment loss (clinical attachment level >7 mm). None of the definitions of periodontitis used resulted in significant differences between groups.

CONCLUSIONS

The relationship between periodontitis and osteoporosis remains unclear, and further studies considering fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.

Factors associated with edentulousness in an elderly population in Valencia (Spain)

OBJECTIVE

To determine the prevalence of edentulism and its association with various socioeconomic factors and oral health habits in the population aged 65-74 years old in the region of Valencia.

METHODS

A cross sectional study was designed. Thirty-four primary health centers and five nursing homes were chosen at random in the region of Valencia (10-15 voluntary participants per sampling point). Clinical examinations were carried out by three calibrated dentists (kappa>0.85) in the same centers. The total sample consisted of 531 individuals (235 men and 296 women).

RESULTS

The percentage of toothlessness was 20.7% and the mean number of natural teeth present was 14.92. The prevalence of edentulism was significantly higher (p <0.05) in men, institutionalized persons, those with no schooling, those with poor oral hygiene, those who visited the dentist regularly and those living in peri-urban/rural areas. In a multivariate logistic regression model with edentulism as the dependent variable, the following factors were identified as significant independent variables: institutionalization (odds ratio [OR]=2.88), poor oral hygiene (OR=2.35), regular visits to the dentist (OR=2.34) and age (OR=1.19).

CONCLUSION

Edentulousness is a complex phenomenon that involves distinct social and economic factors.

Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists

The current rates of edentulism have been estimated to be between 7% and 69% of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, American Dental Association (ADA) Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and were published in February 2011 issue of The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.

Influence of bisphosphonates on alveolar bone loss around osseointegrated implants

The relationship between bisphosphonates (BP) and dental implant failure has not been fully elucidated. The purpose of this retrospective radiographic study was to examine whether patients who take BP are at greater risk of implant failure than patients not using those agents. Treatment records of 362 consecutively treated patients receiving endosseous dental implants were reviewed. The patient population consisted of 227 women and 135 men with a mean age of 56 years (range: 17-87 years), treated in the University at Buffalo Postgraduate Clinic from 1997-2008. Demographic information collected included age, gender, smoking status, as well as systemic conditions and medication use. Implant characteristics reviewed included system, date of placement, date of follow-up radiographs, surgical complications, number of exposed threads, and implant failure. The relationship between BP and implant failure was analyzed using generalized estimating equation (GEE) analysis. Twenty-six patients using BP received a total of 51 dental implants. Three implants failed, yielding success rates of 94.11% and 88.46% for the implant-based and subject-based analyses, respectively. Using the GEE statistical method we found a statistically significant (P  =  .001; OR  =  3.25) association between the use of BP and implant thread exposure. None of the other variables studied were statistically associated with implant failure or thread exposure. In conclusion, patients taking BP may be at higher risk for implant thread exposure.

Edentulism and comorbid factors

INTRODUCTION

Complete edentulism is the terminal outcome of a multifactorial process involving biological factors and patient-related factors. It continues to represent a tremendous global health care burden, and will for the foreseeable future. The purpose of this review is to determine what comorbid factors exist for the completely edentulous patient.

METHODS

This literature review evaluated articles obtained via the National Library of Medicine's PubMed Website, using keywords of edentulism with various combinations of the terms comorbidity, incidence, health, nutrition, cancer, cardiovascular health, diabetes, osteoporosis, smoking, asthma, dementia, and rheumatoid arthritis. Abstracts were selected and screened, and selected full-text articles were reviewed. Articles were limited to those with adequate patient cohorts and a minimum of 2-year follow-up data.

RESULTS

Edentulism was found to be a global issue, with estimates for an increasing demand for complete denture prostheses in the future. Completely edentulous patients were found to be at higher risk for poor nutrition, coronary artery plaque formation (odds ratio 2.32), to be smokers (odds ratio 2.42), to be asthmatic and edentulous in the maxillary arch (odds ratio 10.52), to being diabetic (odds ratio 1.82), to having rheumatoid arthritis (odds ratio 2.27), and to having certain cancers (odds ratios varying from 1.54 to 2.85, depending on the type of cancer). Chronic residual ridge resorption continues to be the primary intraoral complication of edentulation, and there appear to be few opportunities to reduce bone loss in the edentulous patient.

CONCLUSIONS

While the completely edentulous patient seems to be at risk for multiple systemic disorders, whether development of these disorders is causal or casual has not been determined. To minimize the loss of residual alveolar ridges, exemplary complete denture therapy, along with the establishment of routine recall systems, should be the ultimate goal of treatment of this patient cohort.

Inhaled corticosteroid-related tooth problems in asthmatics

BACKGROUND

The recent Global Initiative for Asthma guideline states that inhaled corticosteroids (ICSs) may induce osteoporosis as a systemic adverse effect. New ICSs, such as fluticasone propionate, have a high topical potency and may therefore induce tooth problems as a result of direct exposure without hepatic metabolism more frequently than older ICSs.

OBJECTIVE

We evaluated asthma patients who underwent long-term treatment with a new ICS to determine if they had tooth problems that were related to osteoporosis of the mandible.

METHODS

When the conventional bone mineral density (BMD) of asthmatics that received the ICS treatment for at least one year was measured using dual-energy X-ray absorptiometry, the BMD of the mandible was also measured. The T-score of the mandible BMD was then determined based on the mean BMD +/- the standard deviation of normal young adults.

RESULT

Asthma patients with tooth loss (n = 36) and with caries or other tooth problems (n = 28) were found to have a significantly higher prevalence of osteoporosis in the mandible than those without tooth problems (n = 17; 22.2%, 7.1%, 0%, respectively; chi(2) = 6.34, p < 0.05). In addition, the presence of mandibular osteoporosis (odds ratio: 6.14, p = 0.02) and a T-score of < -1.0 for the femoral neck (odds ratio: 3.25, p = 0.01) were found to be significant risk factors for tooth loss in the asthma patients. Finally, the T-score of the mandible was found to be correlated with age (r = -0.316, p < 0.01), and with the T-scores of the lumbar spine (r = 0.413, p < 0.001) and femoral neck (r = 0.446, p < 0.001).

CONCLUSION

Tooth loss in asthma patients undergoing long-term treatment with a topically potent ICS was found to be related to a decrease in BMD, especially in the mandible. Therefore, patients using these types of ICS should have their mandibular BMD checked regularly, especially if they have any risk factors for osteoporosis. In addition, it would be wise for such patients to reduce their ICS dose.

Risk indicators for missing teeth in working-age Pomeranians--an evaluation of high-risk populations

OBJECTIVE

The goal of this study was to examine whether psychosocial conditions for general health described in the public health literature are also reflected in tooth loss.

METHODS

The relation of psychosocial factors to missing teeth was evaluated among 2,501 individuals aged 25 to 59 years from the population-based cross-sectional Study of Health in Pomerania using logistic regression analyses. The case group included 15 percent of participants of each 5-year age group with the highest number of missing teeth.

RESULTS

Unemployment, dose-dependent current and former smoking, a poor general health status, and a longer time since the last dental appointment were significant risk indicators for missing teeth. Alcohol consumption, use of interdental cleaning products, and checkup as the reason for the last dental visit were protective. Women with low education and low income were identified as a high-risk group for missing teeth by the three-way interaction between gender, school education, and household income. The effect of marital status was modified by gender: being single was a risk indicator for men but it was protective for women.

CONCLUSIONS

The study supports the hypothesis that psychosocial conditions that affect health status as described in the general public health literature also have an effect on tooth loss. Strategies to prevent tooth loss may be expeditiously implemented in combination with approaches to prevent other health-related problems.

A Biomechanical Comparison of 2 Techniques for Reconstructing Atrophic Edentulous Mandible Fractures

OBJECTIVES

The purpose of this investigation was to evaluate and compare the biomechanical behavior of 2 techniques for the reconstruction of atrophic edentulous mandible fractures.

MATERIALS AND METHODS

Thirty polyurethane atrophic edentulous mandible replicas (Sawbones, Vashon Island, WA) were used in this investigation (10 controls, 10 replicas of 2 different fixation techniques). The first reconstruction technique was a traditional titanium locking reconstruction plate affixed to the lateral border (buccal surface) of the mandible. The second reconstruction technique used the same type of plate, but placed it on the inferior border of the mandible. Both constructs were subjected to vertical loading at the symphysis and torsional loading at the body regions of the mandible replicas by an Instron 1331 (Instron, Canton, MA) servohydraulic mechanical testing unit. Mechanical deformation data within a 0-900 N range were recorded. Maximum load, displacement at maximum load, and stiffness were determined. Means and standard deviations were derived and compared for statistical significance using a Fisher's Protected Least Significant Differences Test with a confidence level of 95% (P < .05). Second- and third-order polynomial best-fit curves were also created for each group to further evaluate the mechanical behavior.

RESULTS

For symphysis loading, statistically significant differences were noted between the control group and both of the plating techniques for displacement at maximum load. However, no differences were noted between the experimental groups for displacement at maximum load, stiffness, or maximum load. For body loading, statistically significant differences were noted between the control group and the inferior border plating group for displacement at maximum load. However, no differences were noted between the experimental groups for displacement at maximum load, stiffness, or maximum load.

CONCLUSION

During this bench top investigation, there were no significant differences noted in mechanical behavior between the 2 specific experimental groups for any of the conditions measured. When placed in the context of functional parameters, both of the plating techniques met or exceeded the requirements for loading.

Oral findings and health status among hospitalized patients with physical disabilities, aged 60 or above

The purpose of the study was to determine oral health status and the prevalence of oral mucosal lesions among hospitalized elderly patients with physical disabilities. The study group consisted of 111 (43 male and 68 female) elderly patients with physical disabilities. Clinical examination and interview methods were employed. Clinical examination revealed that 45.9% of the elderly patients had one or more oral mucosal lesions. Xerostomia (58.6%), coated-hairy tongue (54.1%) and halitosis (46.8%) were the most frequently encountered oral findings and mucosal lesions. As the most interesting finding discovered in elderly patients, macroglossia (30.6%) seems to depend on physical disability. Coated or hairy tongue was commonly related to poor oral hygiene, with both crude odds ratio (OR) of 3.25 (95% CI: 1.26-8.36) (P=0.021) and the logistic regression OR of 3.36 (95% CI: 1.21-9.33) (P=0.020). Halitosis and bruxism were commonly related to dentate patients [logistic regression OR of 0.29 (95% CI: 1.12-0.74) (P=0.009) and 0.21 (95% CI: 0.06-0.74) (P=0.016); respectively]. Increase in dental problems may have negative impacts on chewing, nutrition, aesthetics and phonation in elderly patients. It is particularly noteworthy that physical disability in elderly patients limits their ability to effectively follow oral hygiene procedures.

Tooth loss and associated risk indicators in an adult urban population from south Brazil

The aim of the present study was to assess the prevalence, extent, and risk indicators of tooth loss in a representative adult, urban population in the Brazilian state of Rio Grande do Sul. A sample of 974 subjects (ages 30 to 103 years, mean 48.7, SD 13.4) representative of the metropolitan area of Porto Alegre, Brazil was selected by a multi-stage probability cluster sampling strategy. In all, 94% of the subjects had experienced tooth loss. The mean tooth loss was 11.2 teeth, and varied between 5.5 and 20.2 teeth in the 30-39 and 60 + years age groups, respectively. The multivariable analysis, adjusted for age, showed that subjects who had lost 7-13 or > or = 14 teeth were more likely to be females (odds ratio (OR) = 1.4, 2.4), of low (OR = 2.8, 5.1) or middle socio-economic status (OR = 2.3, 3.4), and heavy smokers (OR= 2.0, 2.3) than those with 6 or fewer missing teeth. Furthermore, loss of > or = 14 teeth was associated with presence of > 50% teeth with attachment loss > or = 5 mm (OR= 5.7), and loss of 7-13 teeth was associated with presence of > 50% teeth with attachment loss > or = 5 mm (OR = 2.4) and having 15-30% or > 30% decayed-filled teeth (OR = 2.7 and 4.1). In conclusion, tooth loss is highly prevalent in this urban Brazilian population. Gender, socio-economic status, cigarette smoking, caries experience, and attachment loss are important risk indicators. A reduction in the population's tooth loss may be achieved by the implementation of community programs for the prevention and treatment of dental caries and periodontal diseases.

Periodontal diseases and osteoporosis: association and mechanisms

There is increasing evidence that osteoporosis, and the underlying loss of bone mass characteristic of this disease, is associated with periodontal disease and tooth loss. Periodontitis has long been defined as an infection-mediated destruction of the alveolar bone and soft tissue attachment to the tooth, responsible for most tooth loss in adult populations. Current evidence including several prospective studies supports an association of osteoporosis with the onset and progression of periodontal disease in humans. The majority of studies have shown low bone mass to be independently associated with loss of alveolar crestal height and tooth loss. However studies that focus on the relation of clinical attachment loss and osteoporosis are less consistent. To date, the majority of studies on the relationship between periodontal disease and osteoporosis have been hindered by small sample sizes, limited control of other potential confounding factors, varying definitions of both periodontal disease and osteoporosis, and few prospective studies where the temporality of the association can be established. Potential mechanisms by which host factors may influence onset and progression of periodontal disease directly or indirectly include underlying low bone density in the oral cavity, bone loss as an inflammatory response to infection, genetic susceptibility, and shared exposure to risk factors. Systemic loss of bone density in osteoporosis, including that of the oral cavity, may provide a host system that is increasingly susceptible to infectious destruction of periodontal tissue. Studies have provided evidence that hormones, heredity, and other host factors influence periodontal disease incidence and severity. Both periodontal disease and osteoporosis are serious public-health concerns in the United States. Prevalence of both osteoporosis and tooth loss increase with advancing age in both women and men. Understanding the association between these common diseases and the mechanisms underlying those associations will aid health professionals to provide improved means to prevent, diagnose, and treat these very common diseases. This paper reviews the current evidence on the association between periodontal disease and osteoporosis.