Prevalence and demographic correlates of tooth loss among the elderly in the United States

Periodontal Surgery Combined with Multiple Extractions: A Case Report

BACKGROUND Dental extraction is the only treatment option for terminal stage periodontal disease. Remnants of the pathological periodontal tissue can still be present after the extraction. Periodontal flap surgery contributes to achieving a better regeneration process at the extraction site. This case report includes a unique unconventional approach to periodontal therapy, not commonly reported in the literature. CASE REPORT A 37-year-old man reported mobility and migration of the teeth in both jaws and was referred to the Periodontology Department of the University of Prishtina Dentistry School. The patient had no personal history of any current systemic condition or family history of similar gum conditions. After a clinical and radiographic evaluation (periodontal probing depth and gingival index), most of the front teeth of both jaws were diagnosed with terminal stage periodontal disease (stage 4, grade C). Modified Widman flap periodontal surgery was conducted on the maxilla and mandible to extract most of the front teeth. The sites of tooth extraction underwent profound debridement to remove the pathological soft tissues and sharp bone extrusions. The 4 postoperative follow-up visits at 1, 4, 8, and 10 weeks showed sufficient restitution of the wounds. He received temporary mobile prostheses for the areas with multiple extractions. After 10 weeks, he began treatment for a fixed prosthetic bridge. He had a satisfactory recovery and was followed up over 3 annual visits after his surgery. CONCLUSIONS Multiple extractions can be considered as a treatment option for terminal stage periodontitis.

5-year randomized multicenter clinical trial on single dental implants placed in the midline of the edentulous mandible

OBJECTIVES

This multicenter randomized controlled clinical trial was conducted to investigate whether the loading protocol of single dental implants placed in the midline of edentulous mandibles will influence the implant survival or prosthetic maintenance.

MATERIALS AND METHODS

In total, 158 patients were randomly assigned either to the immediate loading group (n = 81) or to the delayed loading group (n = 77). All implants were loaded with an overdenture retained by a ball attachment.

RESULTS

After 5 years, 102 patients attended the follow-up investigation. Immediately loaded single implants in the midline of the edentulous mandible revealed a statistically significant lower survival rate than implants loaded conventionally over an observation period of 5 years. In the immediate loading group, 9 implants failed within the first three months of implant loading. No further implant loss was recorded for this group. Two implants failed in the delayed loading group, whereas one implant had to be removed during second-stage surgery and the second five years after implant loading. Non-inferiority of the survival rate of the midline implant of the immediate loading group, compared with the delayed loading group, could not be shown (p = .79, CI immediate loading: 74.9%; 100.0%, CI delayed loading: 73.0%; 100.0%). The observed difference in implant survival between the two treatment groups over time was statistically significant.

CONCLUSIONS

The results of the present study indicate that immediate loading of a single mandibular implant in the edentulous mandible should be considered only in exceptional cases.

Patient-reported outcome measures of edentulous patients restored with single-implant mandibular overdentures: A systematic review

AIM

To review the literatures concerning the effect of the single-implant mandibular overdenture (SIMO) on patient-reported outcome measures (PROMs) and masticatory function in the fully edentulous patients.

MATERIALS AND METHODS

Electronic databases (PubMed, Cochrane Library, EMBASE and Web of Science) were searched, complemented with manual resources. Prospective studies published in English up to February 2020 reporting the effect of SIMO on PROMs and masticatory function in the edentulous patients were included. This review focused on oral health-related quality of life (OHRQoL), satisfaction and masticatory function outcomes.

RESULTS

Of 1157 initially screened articles, 9 randomised controlled trials (RCTs) and 8 prospective studies involving 551 subjects fulfilled the inclusion criteria. Two RCTs were graded as high risk of bias or some concern, while others were low risk. All prospective studies had adequate representativeness and assessment, but only one study had a controlled cohort. In general, the edentulous patients restored with SIMOs had improved OHRQoL and general satisfaction compared to those with conventional complete dentures (CCDs), but the outcome of masticatory function was controversial. Compared with two-implant mandibular overdenture (TIMO), SIMO showed no significant differences regarding general satisfaction and satisfaction with speech, comfort, chewing ability, aesthetics and social life. Conflicting results were observed in OHRQoL and satisfaction with retention and stability. Better masticatory performance was observed in TIMO group than SIMO group.

CONCLUSION

Within the limitation of this review, SIMO is featured with better OHRQoL and satisfaction than CCD. SIMO and TIMO rendered similar patient satisfaction, but TIMO had better masticatory performance.

The patient general satisfaction of mandibular single-implant overdentures and conventional complete dentures: Study protocol for a randomized crossover trial

BACKGROUND

Mandibular overdentures retained by a single implant placed in the midline of edentulous mandible have been reported to be more comfortable and function better than complete dentures. Although single-implant overdentures are still more costly than conventional complete dentures, there are a few studies which investigated whether mandibular single-implant overdentures are superior to complete dentures when patient general satisfaction is compared. The aim of this study is to assess patient general satisfaction with mandibular single-implant overdentures and complete dentures.

METHODS

This study is a randomized crossover trial to compare mandibular single-implant overdentures and complete dentures in edentulous individuals. Participant recruitment is ongoing at the time of this submission. Twenty-two participants will be recruited. New mandibular complete dentures will be fabricated. A single implant will be placed in the midline of the edentulous mandible. The mucosal surface of the complete denture around the implant will be relieved for 3 months. The participants will then be randomly allocated into 2 groups according to the order of the interventions; group 1 will receive single-implant overdentures first and will wear them for 2 months, followed by complete dentures for 2 months. Group 2 will receive the same treatments in a reverse order. After experiencing the 2 interventions, the participants will choose one of the mandibular prostheses, and yearly follow-up visits are planned for 5 years. The primary outcome of this trial is patient ratings of general satisfaction on 100 mm visual analog scales. Assessments of the prostheses and oral health-related quality of life will also be recorded as patient-reported outcomes. The secondary outcomes are cost and time for treatment. Masticatory efficiency and cognitive capacity will also be recorded. Furthermore, qualitative research will be performed to investigate the factors associated with success of these mandibular denture types. Clinical outcomes, such as implant survival rate, marginal bone loss, and prosthodontic complications, will also be recorded.

DISCUSSION

The results of this randomized crossover trial will clarify whether mandibular single implants and overdentures for edentulous individuals provide better patient general satisfaction when compared to conventional complete dentures.

TRIAL REGISTRATION

This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center (UMIN000017883).

Meal Patterns of Older Adults in Rural Communities: Life Course Analysis and Implications for Undernutrition

Mealfrequency and composition data were collected in home interviews from a random sample of 556 adults age 55 to 96 years from two rural Kentucky counties Only 65% consumed three meals every day, and less than one third regularly snacked. Factor analysis distinguished patterns of hot, cooked meals from cold, uncooked meals at each meal; patterns varied by sociodemographic characteristics. Qualitative data from in-depth interviews with key infor mants provide context for understanding the influence of life course experiences These data show both continutty of local rural meal patterns and changes informants attribute to life course transitions—the most salient related to family, work, and health status. Knowledge of how meals are patterned and how patterns are distributed can inform efforts to correct or prevent nutritional problems, particularly undernutrition. We suggest ways in which these findings can be applied in programs to improve the nutritional status of elders.

Meaning and Management of Food Security Among Rural Elders

Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. This study uses fixed response and textual data obtained through in-depth interviews with adults 70 years and older from a multiethnic population in rural North Carolina to examine the incidence of food insecurity and how older adults experience food insecurity and maintain food security. We interviewed 145 elders up to five times over the course of 1 year. Responses to standard food insecurity questions indicate that only 12% of older adults experience food insecurity. However, analysis of textual data reveals common themes concerning food insecurity that suggest that these questions may underestimate the number of rural elders who are food insecure and not tap the potential vulnerability of others who are dependent on precarious nutritional self-management strategies to meet their needs.

Detection of the genial spinal canal in atrophic mandibles with a CBCT: a cadaver study

OBJECTIVES

The use of a single midline implant to retain a complete mandibular denture when more implants cannot be used is an incipient treatment modality. However, in the mandibular symphysis, the genial spinal canal (GSC) is an anatomical structure with neurovascular content that can be harmed during dental implant surgery. The purpose of the present study was to use CBCT of edentulous atrophic cadaver mandibles and evaluate how often the simulated placement of a single midline implant would contact the GSC if present.

METHODS

CBCT scans of 47 edentulous cadaver mandibles were performed. A digital simulation of the placement of a single midline implant (3.8 × 11.0 mm) was performed, and the implant-GSC contact was evaluated.

RESULTS

A GSC was detected in the CBCT scan of all atrophic mandibles. In 42 cases (89.4%), the single midline implant contacted the GSC. On average, the five cases without GSC contact had a higher alveolar ridge (4.1 mm) and a lower GSC (0.79 mm) than did the cases with GSC contact.

CONCLUSIONS

CBCT scans can adequately detect the GSC during pre-surgical diagnostics. There is a high risk of implant-GSC contact during surgery of the anterior mandible. However, the clinical relevance of such a contact is not known yet, because none of the clinical studies evaluating a single midline implant has reported any implant-GSC contact-related complications.

Single dental implant retained mandibular complete dentures--influence of the loading protocol: study protocol for a randomized controlled trial

Background

Over the years, there has been a strong consensus in dentistry that at least two implants are required to retain a complete mandibular denture. It has been shown in several clinical trials that one single median implant can retain a mandibular overdenture sufficiently well for up to 5 years without implant failures, when delayed loading was used. However, other trials have reported conflicting results with in part considerable failure rates when immediate loading was applied. Therefore it is the purpose of the current randomized clinical trial to test the hypothesis that immediate loading of a single mandibular midline implant with an overdenture will result in a comparable clinical outcome as using the standard protocol of delayed loading.

Methods/design

This prospective nine-center randomized controlled clinical trial is still ongoing. The final patient will complete the trial in 2016. In total, 180 edentulous patients between 60 and 89 years with sufficient complete dentures will receive one median implant in the edentulous mandible, which will retain the existing complete denture using a ball attachment. Loading of the median implant is either immediately after implant placement (experimental group) or delayed by 3 months of submerged healing at second-stage surgery (control group). Follow-up of patients will be performed for 24 months after implant loading. The primary outcome measure is non-inferiority of implant success rate of the experimental group compared to the control group. The secondary outcome measures encompass clinical, technical and subjective variables. The study was funded by the Deutsche Forschungsgemeinschaft (German research foundation, KE 477/8-1).

Discussion

This multi-center clinical trial will give information on the ability of a single median implant to retain a complete mandibular denture when immediately loaded. If viable, this treatment option will strongly improve everyday dental practice.

Trial registration

The trial has been registered at Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS-ID: DRKS00003730 since 23 August 2012. (http://www.germanctr.de).

Oral diagnostics: an integral component to geriatric health care

Aging is inevitable, every day we live we age. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. Oral health reflects overall well being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in age. Diagnosis and proper treatment is essential for healthy aging. Timely diagnosis, appropriate treatment and regular follow-up of both oral and systemic diseases are a prerequisite for active aging. Oral diagnostics is a revolutionary development with high potential to replace other investigative modalities. Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. This paper is aimed to shed light on the growing elderly population and their ailments. It also aims to create awareness among health care providers about oral diagnostics and their application in geriatrics.

Sex/Gender differences in tooth loss and edentulism: historical perspectives, biological factors, and sociologic reasons

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

Reasons for extraction of permanent teeth in general dental practices in Tehran, Iran

OBJECTIVES

The aim of this survey was to investigate the primary reason for extraction of permanent teeth, its correlations with age, gender and education level, as well as identify the important predictors for dental caries in general dental centers in Tehran, Iran.

SUBJECTS AND METHODS

The study was conducted over a period of 6 months; its population consisted of 1,382 patients, aged 9-95 years, who underwent tooth extraction. There were 673 (47.8%) male and 709 (51.3%) female patients. The frequency distribution was calculated using the χ(2) test, ANOVA and t test for differences in mean number of extracted teeth and the logistic regression model to evaluate the variables associated with reasons for tooth extraction.

RESULTS

A total of 2,620 teeth were extracted from the 1,382 patients. The highest rate (36.9%) of extraction occurred for those 41-60 years old. Males comprised 48.7% of patients but had more teeth (1,470, 55.3%) extracted than females (1,150, 43.9%). Nine hundred and thirty-six (67.7%) patients had incomplete secondary education or less. Tooth loss due to caries was 51%; periodontal disease was 14.4%; supernumerary and tooth impaction 13.9%. There was a significant association between patient characteristics (age, gender and education level) and number of teeth extracted.

CONCLUSION

Dental caries and periodontal disease were the main reasons for tooth extraction in Tehran, Iran.

Tooth loss and dental caries in community-dwelling older adults in northern Manhattan

OBJECTIVE

To examine tooth loss and dental caries by sociodemographic characteristics from community-based oral health examinations conducted by dentists in northern Manhattan.

BACKGROUND

The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City.

MATERIALS AND METHODS

Self-reported sociodemographic characteristics and health and health care information were provided by community-dwelling ElderSmile participants aged 65 years and older who took part in community-based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%).

RESULTS

The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non-Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism.

CONCLUSION

Provision of oral health screenings in community-based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.

Investing in preventive dental care for the Medicare population: a preliminary analysis

OBJECTIVES

We estimated the use of preventive dental care services by the US Medicare population, and we assessed whether money spent on preventive dental care resulted in less money being spent on expensive nonpreventive procedures.

METHODS

We used data from the 2002 Medicare Current Beneficiary Survey to estimate a multinomial logistic model to analyze the influence of predisposing, enabling, and need variables in identifying those beneficiaries who used preventive dental care, only nonpreventive dental care, or no dental care in a multiple-variable context. We used regression models with similar controls to estimate the influence of preventive care on the utilization and cost of nonpreventive dental care and all dental care.

RESULTS

Our analyses showed that beneficiaries who used preventive dental care had more dental visits but fewer visits for expensive nonpreventive procedures and lower dental expenses than beneficiaries who saw the dentist only for treatment of oral problems.

CONCLUSIONS

Adding dental coverage for preventive care to Medicare could pay off in terms of both improving the oral health of the elderly population and limiting the costs of expensive nonpreventive dental care for the dentate beneficiary population.

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.

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.

Why do some people lose teeth across their lifespan whereas others retain a functional dentition into very old age?

OBJECTIVES

To analyse the importance of caries, periodontitis, and medical and psychosocial factors for risk of becoming edentulous across their lifespan and to examine factors critical for retaining functional dentition into very old age.

METHODS

From the longitudinal population-based Octogenarian Twin study which analysed psychosocial and health variables, 357 individuals aged 82 + in 1995-1998 were collected. Information about number of teeth, decayed and filled surfaces percentage and periodontal disease experience were drawn from dental records. Reasons for and time of edentulousness were recorded.

RESULTS

Outcome varied - depending on perspective and factors for losing or retaining teeth. Significant factors for losing teeth varied over the lifespan. Losing teeth early in life was related to lower social class; in middle age, to lower education; and in old age, to poor lifestyle factors and low social class. Caries constituted the main reason for tooth loss (about 55%). This increased substantially in the >80 year age-group (75%). Maintaining a functional dentition into old age was significantly associated with non-smoking, more education, being married and good periodontal health.

CONCLUSION

It is important to apply life-span and cohort perspectives to oral health and disease. In our sample of persons born before World War I, caries was the main reason for losing all teeth, with substantially increased prevalence by age. Lifestyle factors were significant for losing and for retaining teeth. Periodontal condition had a significant influence on the likelihood of retaining functional dentition, and also when taking psychosocial variables into account.

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.

A Single-Item Approach to Screening Elders for Oral Health Assessment

BACKGROUND

Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important.

OBJECTIVES

The objective of this article was to evaluate usefulness of the item: "Do you have regular dental checkups?" as a means to decide whether an oral health assessment or further referral is indicated. Answering no is postulated as a positive predictor of poor oral health and need for care.

METHODS

This study was a secondary analysis of a nutritional survey of 240 community-dwelling elders. Examiner-rated Kayser-Jones Brief Oral Health Status Examination; self-reported General Oral Health Assessment Index; number of remaining teeth; and pattern of checkups (regular vs. irregular) were evaluated by a trained gerontological nurse practitioner during an in-home assessment.

RESULTS

A dental visit within the past year for any reason was reported by 132 subjects (55.0%), but only 81 (33.8%) reported some sort of regular dental checkups. For dentate elders (n = 147), an irregular checkup was associated with lower educational level, Protestant faith, and Black race. People with irregular checkups scored significantly lower on all three oral indices. The negative predictive values and likelihood ratio negative values ranged 98.7-100.0% and 0.00-0.98, respectively, indicating that this item of interest is valid for ruling-out dentate subjects with good oral health. For edentulous elders (n = 93), the item was less effective.

DISCUSSION

A single item, "Do you have regular dental checkups?" can be used effectively to rule out dentate elders with good oral health and identify those who are in need of further oral health assessment or referrals.

Influência da aculturação na autopercepção dos idosos quanto à saúde bucal em uma população de origem japonesa

O presente estudo busca avaliar a influência da aculturação da população idosa na autopercepção de sua saúde bucal, utilizando metodologia qualitativa. A população-alvo foi composta por quarenta indivíduos divididos em dois grupos principais, o dos pertencentes à primeira geração de imigrantes japoneses e o da segunda geração. Mediante entrevista gravada, foi avaliado o nível de aculturação de cada grupo e sua influência sobre os cuidados tomados com a saúde bucal, a auto-avaliação da condição bucal e o tempo decorrido desde a última visita ao cirurgião-dentista. O processo de aculturação atinge ambos os grupos, porém com maior intensidade o grupo da segunda geração; isso, no entanto, não interfere na autopercepção da saúde bucal desta população. Os principais cuidados tomados com a saúde bucal foram: escovação, uso do fio dental e imersão da prótese em soluções anti-sépticas. Na auto-avaliação da condição bucal, as principais queixas se deram em relação ao uso de próteses; o tempo decorrido desde a última visita ao cirurgião-dentista foi, em média, de 1,4 ano para os não edêntulos e 6,3 anos para os edêntulos.

Reasons for tooth extraction in Kuwait

OBJECTIVES

To investigate reasons for tooth extraction and its association with age and gender in Kuwait.

SUBJECTS AND METHODS

A record of all tooth extractions performed in 21 general dental practice centers during a 1-month period was logged on specially designed study forms. The patient's age and gender, number of teeth extracted, and the reason(s) for the extraction were recorded.

RESULTS

A total of 2,783 teeth were extracted in 1,604 patients (1.73 +/- 0.07 teeth per patient). Caries and periodontal disease were responsible for 43.7 and 37.4% of extractions, respectively. Caries was the principal cause for extraction in patients < or =40 years old (60.7%), while periodontal disease was the main cause of extractions in patients > or =40 years of age (63.0%). Extractions for caries and orthodontic reasons were more common in females, while extractions for periodontal disease were more prevalent in males. Molars and maxillary premolars were more commonly extracted due to caries, while mandibular premolars, and maxillary and mandibular anterior teeth (canines and incisors) were more commonly extracted due to periodontal disease.

CONCLUSIONS

The data show that caries is the principal cause for extractions in younger patients, while periodontal disease accounts for the majority of tooth extractions in patients older than 40 years. Furthermore, this study indicates that more teeth per patient are lost to periodontal disease than for any other reason.

Dental health of elderly confederate veterans: evidence from the Texas State Cemetery

Analysis of the skeletal remains of 50 Confederate veterans provided a unique opportunity to explore the dental health of a geriatric sample. These men, who died between 1907-1932, had an average age at death of 76.7 years. Ninety percent were institutionalized at the Confederate Home for Men (Austin, TX) prior to their deaths. This elderly sample was assessed in terms of caries, antemortem tooth loss (AMTL), abscesses, and linear enamel hypoplasias. On a per tooth basis, the AMTL rate was 57.2%. Of 39 dentate men, 33 (84.6%) had dental caries, and 24.4% (121 of 496) of teeth were carious. Ten (25.0%) of the dentate men had hypoplastic teeth. At least one abscess was seen in 14 (28%) of 50 individuals. Results from this geriatric institutionalized sample are compared to contemporaneous historical samples. Disparities in dental health among these groups may be due to differences in average age at death, and these comparisons allow a better understanding of dental changes that occur with age. The sample is also compared to modern elderly samples: modern groups have higher caries rates, possibly because they retained more teeth. This finding may be due in part to diets in the United States becoming increasingly cariogenic over time. In addition, dental care has moved from the reactive practices seen in the nineteenth and early twentieth centuries (such as tooth extractions) to modern proactive solutions dedicated to preserving and restoring teeth (such as tooth brushing, fluoride treatments, and dental fillings).

The mandibular complete overdenture

Mandibular complete overdenture treatment has been available for decades, but its use was limited when the treatment relied on retained teeth as overdenture abutments. This treatment, however, is currently experiencing more popularity than ever before. In fact, dentistry may be experiencing a philosophical shift, in which mandibular implant overdenture treatment may become the new standard of care for the treatment of the edentulous mandible. Practitioners are looking for simplified treatments that can provide cost-effective alternatives to more complex implant prosthodontic procedures. Implant overdentures provide a strong return for the investment in treatment time and expense and are a treatment suited to the lower socioeconomic status of many edentulous patients. The clinical outcome of this treatment is significantly better than that achieved with conventional mandibular dentures, especially when patients are experiencing technical problems because of compromised prosthesis retention or stability.

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.

Quality of diets consumed by older rural adults

Older adults residing in rural communities are at risk for low dietary quality because of a variety of social, physical and environmental circumstances. Minority elders are at additional risk because of poorer health status and lower socioeconomic status. This study evaluated the food group intake of 130 older (>70 years) African American (34%), European American (36%), and Native American (30%) residents of two rural communities in central North Carolina. An interviewer-administered food frequency questionnaire was used to measure dietary intake. Food items were classified into food groups similar to the United States Department of Agriculture (USDA) Food Guide Pyramid and the National Cancer Institutes 5 A Day for Better Health program. None of the survey participants met minimum intake recommendations and most over-consumed fats, oils, sweets and snacks. African Americans and Native Americans consumed fewer servings of meats,fruits and vegetables, and fats, oils, sweets and snacks than European Americans. African American men consumed the fewest servings of fruits and vegetables of all gender/ethnic groups. Consumption of fats, oils and sweets was greatest among those 85 years and older and was more common among denture users. National strategies to educate the public about the importance of consuming a varied diet based on the recommendations presented in national nutrition education campaigns may not be reaching older adults in rural communities, particularly minority group members.

Prevalence of tooth loss and dental service use in older Mexican Americans

OBJECTIVES

To describe the prevalence of tooth loss, to examine risk factors for having fewer teeth or no teeth, and to describe the use of dental services in an older Mexican-American population.

DESIGN

Data from the baseline phase of the Hispanic Established Population for the Epidemiological Study of the Elderly survey conducted from 1993 to 1994, a cross-sectional survey of older Mexican Americans.

SETTING

Five southwestern states: Texas, California, Arizona, New Mexico, and Colorado.

PARTICIPANTS

3,050 noninstitutionalized Mexican Americans age 65 to 99.

RESULTS

Twenty-seven percent of the sample was completely edentulous and 22% reported visiting or speaking with a dental care professional in the preceding year. Logistic regression analyses showed that being older or being female was significantly associated with tooth loss, adjusting for education, income, smoking status, and diabetes mellitus. Current smokers (odds ratio (OR) = 1.69; 95% CI = 1.31-2.20) and diabetics (OR = 1.53; 95% CI = 1.27-1.84) were more at risk for tooth loss, as were persons of lower socioeconomic status.

CONCLUSIONS

The prevalence of tooth loss and use of dental services in this population of older Mexican Americans is lower than what has been previously found among older people in the general population.

Tooth loss and need for extractions in American Indian and Alaska Native dental patients

OBJECTIVE

This article reports results of the 1991 Indian Health Service Patient Oral Health Survey in the areas of tooth loss and need for tooth extraction.

METHODS

The survey examined a sample of American Indian and Alaska Native dental patients. Tooth loss and need for tooth extraction are explored for a total of 12,349 individuals aged 18 years and older.

RESULTS

Complete tooth loss in patients aged 35 years and older was 11 percent; in patients aged 65 years and older, it was 42 percent. The mean number of remaining teeth in dentate patients aged 35 years and older was 20.7; the mean number of remaining teeth decreased in each older age group. Partial and complete tooth loss were more severe in diabetic patients. In 35- to 44-year-old patients, only 20 percent had not lost at least one permanent tooth. The prevalence of tooth loss differs by geographic region. The percentage of dental patients with 20 or more teeth increased between 1984 and 1991.

CONCLUSION

Tooth loss remains a substantial problem in American Indian and Alaska Native adult dental patients. This article presents results of an Indian Health Service (IHS) oral health survey conducted in 1991 of the American Indian and Alaska Native (Native American) population with respect to tooth loss. Limited comparisons of tooth loss observed in the 1991 patient survey are made to the 1984 patient survey.

An index of clinical oral disorder in elders (CODE)

Attempts to construct an index of oral health or disorder suitable for older adults have been limited in clinical scope or based on the judgement of very few individuals. Consequently, we present here a multidimensional index of Clinical Oral Disorder in Elders (CODE) based on a breadth of clinical measures relevant to elders. The data for the index are derived from a clinical examination of jaw function, dentures, mucosa, teeth, and periodontium. Weighting or ranking for each disorder within the context of an elderly person was established as mild, moderate or severe by experienced dental clinicians and dental hygienists. Subsequently, the index was constructed by transforming the weights into a numerical value for each clinical measure. Individual scores can relate to the heaviest weight identified during the examination or to the sum of the weights assigned throughout the examination, and the average score during a series of examinations will reflect the clinical status of a particular population. Clinical applications in elderly residential-care populations indicate that the index can be constructed efficiently and with reasonable reliability. We suggest, therefore, that the CODE index is suitable for descriptive and comparative research by providing a clinical format for measuring oral disorder in disabled elders, and, when combined with a psychosocial index, it should be very comprehensive indicator of oral dysfunction in older adults.

Preventive dental behaviors and their association with oral health status in older white men

While prevention practices are widely encouraged, the link between the performance of preventive behaviors and oral health status has rarely been examined. This study investigates the association between preventive dental behaviors (recent and long-term) and oral health status and compares the strength of such associations. Longitudinal data over six time points on 649 dentate white men were obtained from the VA Dental Longitudinal Study (DLS). Participants' oral health was measured through dental examinations, and preventive dental behaviors--i.e., toothbrushing, flossing, using interdental devices, seeking dental prophylaxis, and undergoing dental treatment-were assessed by self-report. Oral health status was measured in terms of (1) functioning teeth, (2) sound-equivalent teeth, (3) decayed, missing, and filled teeth, and (4) decayed and filled root surfaces. Pearson correlation and linear regression analysis revealed significant positive associations between most preventive behaviors and measures of oral health status. Dental prophylaxis emerged as the strongest predictor of oral health status. Long-term preventive dental behavior measures explained more variance in oral health status than short-term preventive behaviors measured cross-sectionally.

The economics of complete dentures and implant-related services: a framework for analysis and preliminary outcomes

It is not always clear that the implant-prosthesis offers distinct advantages over the conventional complete denture for managing the edentulous jaw. This article discusses the measurement, distribution, impact, and management of the edentulous jaw, and describes a framework for analyzing the economic costs and benefits associated with the conventional denture and the implant prosthesis. There are physiologic and psychosocial costs and benefits to both the conventional denture and the implant prosthesis, which indicates that neither method is distinctly superior. The physiologic costs are low and the psychosocial costs are similar for both treatments, whereas the direct financial costs associated with the implant prosthesis are substantially higher.

The impact of the demographics of aging and the edentulous condition on dental care services

Over the next 20 years, the number of people aged 65 years and older is expected to increase substantially in both Canada and the United States. Moreover, advances in dental treatment are resulting in reduced levels of the edentulous condition, such that there will be more people in need of various dental services. The purpose of this study was to determine what effect the increase in the overall population of the United States and Canada, and specific cohorts such as the senior citizen population, would have on the decrease in the levels of the edentulous condition. Through the use of population data obtained through Statistics Canada and the U.S. Census Bureau, it was determined that there will be 25.2% more Americans and 36.5% Canadians who are 65 years of age and over. Furthermore, an algorithm was developed using the United States national tooth loss data, which determined the percentage of people who would be edentulous at 75 years of age and older. The tooth retention rate improves with the younger age cohorts. The 50- to 54-year age group in the year 2000 will, on average, have 6.6 more teeth than the current elderly when they are 75 years of age and older. The percentage of the edentulous condition for the 75-plus age group will decrease by about 50% over the 35-year period from 1990 to 2025. The clinical significance of this trend means that there will be more people with more teeth in need of various dental treatments.

The effects of simple interventions on tooth mortality: findings in one trial and implications for future studies

The purpose of this report was to use a particular clinical trial, the Preventive Geriatric Trial (PGT), as a starting point to discuss whether treatment efficacy can be evaluated by means of tooth mortality. In the PGT, 296 subjects were recruited and randomly assigned to five treatment groups: (1) usual procedures (UP); (2) UP + a cognitive-behavioral intervention (CB); (3) UP + CB + weekly chlorhexidine rinse (CHX); (4) UP + CB + CHX + semi-annual fluoride varnish (F); and (5) UP + CB + CHX + F + semi-annual prophylaxis, including scaling (P). Exploratory analyses revealed that tooth mortality after the 1st year was lower in treatment groups 3, 4, and 5 than in groups 1 and 2. A one-year exposure resulted in a 45% reduction in tooth mortality (p < 0.05); a two-year exposure resulted in a 59% reduction (p-value < 0.04). The PGT findings suggested that it is possible to design trials based on clinically relevant endpoints, such as tooth mortality. For the detection of moderate treatment effects, such trials could take the form of Large, Simple Trials (LST), where many subjects are recruited with minimally restrictive entry criteria, and data are collected only on essential baseline characteristics and tooth mortality. LSTs have provided "reliable answers to important clinical questions" for other chronic diseases, and several arguments suggest that they could play a similar critical role in dental research: (1) Periodontitis and caries are among the most common and costly chronic diseases affecting humans, and the identification of even moderately effective treatments by LSTs can have a large socio-economic impact; (2) the identification of low-cost widely practicable treatments that lend themselves to be investigated in LSTs is likely to benefit more people than the identification of high-cost complex treatments; and (3) tooth mortality is simple to assess and more relevant than the unvalidated surrogate endpoints that have largely failed for more than 20 years to provide reliable answers to certain controversial issues regarding treatment efficacy. The cost of not reliably establishing the safety and the efficacy of treatments may be far greater than the cost of conducting LSTs.

Survey of reasons for extraction of permanent teeth in Italy

The purpose of the study is to collect information on the reasons given by dentists, randomly selected from the Italian Dental and Maxillo-Facial Association's, for extracting permanent teeth in Italy. From the 164 dentists responding, 1056 teeth in 839 patients were extracted during two weeks of working activity. More than two-thirds of the teeth were extracted for dental caries (34.4%) and periodontal disease (33.1%). The mean number of teeth extracted per patient showed a significant increasing trend with increasing age, being 1.09 in those from 16 to 39 yr, 1.25 in the 40-59-yr-old group, to 1.54 in those over 59 yr of age (F = 21.44; P < 0.0001). The third molar was the most frequently extracted tooth and 41.3% were removed due to impaction reasons, in particular from the mandible. The first and second molars and the premolars were extracted most often because of caries; more than half of the incisors and the canines were extracted for periodontal reasons; the majority of the teeth removed for prosthetic reasons, 57.1%, were incisors and canines, especially in the mandible; of the teeth extracted for orthodontic reasons, 47.4% were first and second premolars. The prevalence of subjects with at least one tooth extracted for dental caries and for orthodontic reasons were respectively significantly higher in the irregular than the regular attenders (chi-square = 46.55; P < 0.0001), and in the regular than the irregular dental attenders (chi-square = 63.12; P < 0.0001). Dental practitioners should promote targeted initiatives for prevention and treatment of diseases in order to reduce in particular the incidence of tooth extraction because of caries and periodontal disease.

Factors related to the non-attendance in a clinical oral health study on the home-dwelling old elderly

OBJECTIVE

To evaluate how elderly home-dwelling subjects' background factors, state of health, functional capacity and edentulousness related to their attendance in a comprehensive clinical dental study.

DESIGN

Cross-sectional population study; interview and clinical dental data.

SETTING

The City of Helsinki; clinical dental examinations at the Institute of Dentistry, University of Helsinki.

SUBJECTS

600 elderly aged 76, 81 and 86 years, participants in the medical examinations in the Helsinki Ageing Study one year earlier, 81% being home-dwelling.

MEASURES

Age, gender, marital status, family structure, educational level, former line of work, self-perceived general health, dentulousness, ability to move, sense of hearing, state of memory, clinical findings of dementia, other medical diagnoses, and intake of drugs.

OUTCOME MEASURE

Participation in clinical dental examinations.

RESULTS

The overall participation was 63% being reduced by high age and female gender, 75% of the 76-year-olds, but only 53% of those aged 81 or 86 years were clinically examined, figures were for men 72% and for women 60%. As shown by a multifactorial logit model, the strongest factors related to non-participation were the home-dwelling subjects' old age (OR = 3.6), deteriorated ability to move (OR = 5.3), clinically diagnosed symptoms of dementia (OR = 4.1), or edentulousness (OR = 2.5).

CONCLUSION

Non-participation selectively by those edentulous will lead to prevalence figures on numbers of teeth being too optimistic for the entire elderly population.

Tooth retention and tooth loss in the permanent dentition of adults: United States, 1988-1991

While the overall prevalence of tooth loss and edentulism has been declining in the United States over the past several decades, important variations remain among subgroups of the population. Data from Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III) provide the most current estimates of the prevalence and distribution of tooth retention and tooth loss in the United States. Weighted analyses were conducted for all adults 18+ years of age (n=8,366) and for selected age, gender, and race-ethnicity groups. In 1988-91, 89.5% of the population was dentate, and 30.5% had retained all 28 teeth. The mean number of teeth retained was 21.1 for all adults and 23.5 for dentate persons. The most commonly retained teeth in the mouth were the six anterior teeth in the lower arch. Conversely, 10.5% of the population was edentulous. Partial edentulism was much more common in the upper arch than in the lower arch. The most commonly missing teeth were the first and second molars. Age was strongly related to every measure of tooth retention and tooth loss. Gender was not related to any of these measures, after adjustment for age. Race-ethnicity was consistently related to these measures, after adjustment for age and gender. In general, Mexican-Americans had the lowest and black non-Hispanics the highest rates of tooth loss. Future research needs to examine a wide range of potential correlates of tooth retention and tooth loss before we can understand the complex interplay among the personal, dental, and environmental factors influencing tooth retention and tooth loss in the United States.