Relationship between tooth loss and electrocardiographic abnormalities in octogenarians

Nitinol Type Alloys General Characteristics and Applications in Endodontics

A very extensive literature review presents the possibilities and needs of using, in endodontics, the alloys commonly known as nitinol. Nitinol, as the most modern group of engineering materials used to develop root canals, is equilibrium nickel and titanium alloys in terms of the elements’ atomic concentration, or very similar. The main audience of this paper is engineers, tool designers and manufacturers, PhD students, and students of materials and manufacturing engineering but this article can also certainly be used by dentists. The paper aims to present a full material science characterization of the structure and properties of nitinol alloys and to discuss all structural phenomena that determine the performance properties of these alloys, including those applied to manufacture the endodontic tools. The paper presents the selection of these alloys’ chemical composition and processing conditions and their importance in the endodontic treatment of teeth. The results of laboratory studies on the analysis of changes during the sterilization of endodontic instruments made of nitinol alloys are also included. The summary of all the literature analyses is an SWOT analysis of strengths, weaknesses, opportunities, and threats, and is a forecast of the development strategy of this material in a specific application such as endodontics.

What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics?

This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.

Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment?

The paper is an extensive monographic review of the literature, and also uses the results of the authors’ own experimental research illustrating the noticed developmental tendencies of the filling material based on gutta-percha. The whole body of literature proves the correctness of the research thesis that this material is the best currently that can be used in endodontics. Caries is one of the most common global infectious diseases. Since the dawn of humankind, the consequence of the disease has been the loss of dentition over time through dental extractions. Both tooth caries and tooth loss cause numerous complications and systemic diseases, which have a serious impact on insurance systems and on the well-being, quality, and length of human life. Endodontic treatment, which has been developing since 1836, is an alternative to tooth extraction. Based on an extensive literature review, the methodology of qualifying patients for endodontic treatment was analyzed. The importance of selecting filling material and techniques for the development and obturation of the root canal during endodontic treatment was described. Particular attention was paid to the materials science aspects and the sequence of phase transformations and precipitation processes, as well as the need to ensure the stoichiometric chemical composition of Ni–Ti alloys, and the vacuum metallurgical processes and material processing technologies for the effects of shape memory and superelasticity, which determine the suitability of tools made of this alloy for endodontic purposes. The phenomena accompanying the sterilization of such tools, limiting the relatively small number of times of their use, play an important role. The methods of root canal preparation and obturation methods through cold side condensation and thermoplastic methods, including the most modern of them, the thermo-hydraulic condensation (THC) technique, were analyzed. An important element of the research hypothesis was to prove the assumption that to optimize the technology of development and obturation of root canals, tests of filling effectiveness are identified by the density and size of the gaps between the root canal wall, and the filling methods used and devices appropriate for material research, using mainly microscopy such as light stereoscopic (LSM) and scanning electron (SEM). The most beneficial preparations were obtained by making a longitudinal breakthrough of 48 natural human teeth, extracted for medical reasons, different from caries, with compliance with all ethical principles in this field. The teeth were prepared using various methods and filled with multiple obturation techniques, using a virtual selection of experimental variants. The breakthroughs were made in liquid nitrogen after a one-sided incision with a narrow gap created by a diamond disc using a materialographic cutter. The best effectiveness of the root canal filling was ensured by the technology of preparing the root canals with K3 rotary nitinol tools and filling the teeth with the THC thermoplastic method using the System B and Obtura III devices with studs and pellets of filling material based on gutta-percha after covering the root canal walls with a thin layer of AH Plus sealant. In this way, the research thesis was confirmed.

Virtual Approach to the Comparative Analysis of Biomaterials Used in Endodontic Treatment

The importance of endodontics is presented within our own concept of Dentistry Sustainable Development (DSD) consisting of three inseparable elements; i.e., Advanced Interventionist Dentistry 4.0 (AID 4.0), Global Dental Prevention (GDP), and the Dentistry Safety System (DSS) as a polemic, with the hypothesis of the need to abandon interventionist dentistry in favour of the domination of dental prevention. In view of the numerous systemic complications of caries that affect 3−5 billion people globally, endodontic treatment effectively counteracts them. Regardless of this, the prevention of oral diseases should be developed very widely, and in many countries dental care should reach the poorest sections of society. The materials and methods of clinical management in endodontic procedures are characterized. The progress in the field of filling materials and techniques for the development and obturation of root canals is presented. The endodontics market is forecast to reach USD 2.1 billion in 2026, with a CAGR of 4.1%. The most widely used and recognized material for filling root canals is gutta-percha, recognized as the “gold standard”. An alternative is a synthetic thermoplastic filler material based on polyester materials, known mainly under the trade name Resilon. There are still sceptical opinions about the need to replace gutta-percha with this synthetic material, and many dentists still believe that this material cannot compete with gutta-percha. The results of studies carried out so far do not allow for the formulation of a substantively and ethically unambiguous view that gutta-percha should be replaced with another material. There is still insufficient clinical evidence to formulate firm opinions in this regard. In essence, materials and technologies used in endodontics do not differ from other groups of materials, which justifies using material engineering methodology for their research. Therefore, a detailed methodological approach is presented to objectify the assessment of endodontic treatment. Theoretical analysis was carried out using the methods of procedural benchmarking and comparative analysis with the use of contextual matrices to virtually optimize the selection of materials, techniques for the development and obturation of root canals, and methods for assessing the effectiveness of filling, which methods are usually used, e.g., in management science, and especially in foresight research as part of knowledge management. The results of these analyses are presented in the form of appropriate context matrices. The full usefulness of the research on the effectiveness and tightness of root canal filling using scanning electron microscopy is indicated. The analysis results are a practical application of the so-called “digital twins” approach concerning the virtual comparative analysis of biomaterials used in endodontic treatment.

The Concept of Sustainable Development of Modern Dentistry

This paper concerns the assessment of the current state of dentistry in the world and the prospects of its sustainable development. A traditional Chinese censer was adopted as the pattern, with a strong and stable support on three legs. The dominant diseases of the oral cavity are caries and periodontal diseases, with the inevitable consequence of toothlessness. From the caries 3.5–5 billion people suffer. Moreover, each of these diseases has a wide influence on the development of systemic complications. The territorial range of these diseases and their significant differentiation in severity in different countries and their impact on disability-adjusted life years index are presented (DALY). Edentulousness has a significant impact on the oral health-related quality of life (OHRQoL). The etiology of these diseases is presented, as well as the preventive and therapeutic strategies undertaken as a result of modifying the Deming circle through the fives’ rules idea. The state of development of Dentistry 4.0 is an element of the current stage of the industrial revolution Industry 4.0 and the great achievements of modern dental engineering. Dental treatment examples from the authors’ own clinical practice are given. The systemic safety of a huge number of dentists in the world is discussed, in place of the passive strategy of using more and more advanced personal protective equipment (PPE), introducing our own strategy for the active prevention of the spread of pathogenic microorganisms, including SARS-CoV-2. The ethical aspects of dentists’ activity towards their own patients and the ethical obligations of the dentist community towards society are discussed in detail. This paper is a polemic arguing against the view presented by a group of eminent specialists in the middle of last year in The Lancet. It is impossible to disagree with these views when it comes to waiting for egalitarianism in dental care, increasing the scope of prevention and eliminating discrimination in this area on the basis of scarcity and poverty. The views on the discrimination of dentistry in relation to other branches of medicine are far more debatable. Therefore, relevant world statistics for other branches of medicine are presented. The authors of this paper do not agree with the thesis that interventional dental treatment can be replaced with properly implemented prophylaxis. The final remarks, therefore, present a discussion of the prospects for the development of dentistry based on three pillars, analogous to the traditional Chinese censer obtaining a stable balance thanks to its three legs. The Dentistry Sustainable Development (DSD) > 2020 model, consisting of Global Dental Prevention (GDP), Advanced Interventionist Dentistry 4.0 (AID 4.0), and Dentistry Safety System (DSS), is presented.

Non-Antagonistic Contradictoriness of the Progress of Advanced Digitized Production with SARS-CoV-2 Virus Transmission in the Area of Dental Engineering

The general goals of advanced digitized production in the Industry 4.0 stage of the industrial revolution were presented along with the extended holistic model of Industry 4.0, introduced by the authors, indicating the importance of material design and the selection of appropriate manufacturing technology. The effect of the global lockdown caused by the SARS-CoV-2 virus transmission pandemic was a drastic decrease in production, resulting in a significant decrease in the gross domestic product GDP in all countries, and gigantic problems in health care, including dentistry. Dentists belong to the highest risk group because the doctor works in the patient’s respiratory tract. This paper presents a breakthrough authors solution, implemented by the active SPEC strategy, and aims to eliminate clinical aerosol at the source by negative pressure aspirating bioaerosol at the patient’s mouth line. The comparative benchmarking analysis and its results show that only the proprietary solution with a set of devices eliminates the threat at the source, while the remaining known methods do not meet the expectations. The details of this solution are described. Photopolymer materials and additive Digital Light Printing (DLP) technology were used.

Tooth loss, swallowing dysfunction and mortality in Japanese older adults receiving home care services

AIM

Severe tooth loss and swallowing dysfunction occur more frequently in dependent older adult populations. Poor oral health and functional status are expected to have a negative impact on general health. We examined whether mortality is related to the number of teeth and swallowing function in dependent older Japanese individuals receiving home care services.

METHODS

Older adults aged ≥65 years who were receiving home care were included. The planned follow-up period was 3 years. Baseline data on the number of teeth, swallowing function, nutritional status, cognitive ability and activities of daily living were collected.

RESULTS

A total of 259 participants (mean age 85.0 ± 7.7 years) were enrolled. The mean length of follow up was 26.2 months. Severe tooth loss (≤9 present teeth) and swallowing dysfunction were observed in 68.0% and 32.0% of the participants, respectively. Cox's proportional hazards regression model showed that participants with both ≤9 teeth and swallowing dysfunction were at a higher risk of mortality compared with those with both ≥10 teeth and normal swallowing function (hazard ratio 2.89, 95% confidence interval 1.22-6.83). A significant interaction among severe tooth loss, swallowing dysfunction and mortality risk was observed.

CONCLUSIONS

Severe tooth loss and swallowing dysfunction were associated with increased mortality. The present study suggests that the maintenance of oral health and swallowing function has a positive effect on general health. Therefore, attention should be given to both tooth loss and swallowing function in dependent older adult populations. Geriatr Gerontol Int 2018; 18: 873-880.

Oral inflammation and infection, and chronic medical diseases: implications for the elderly

Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.

Tooth loss among the elders in an inner city area of Ibadan, Nigeria

OBJECTIVE

To determine the prevalence and factors associated with tooth loss among elders in an inner city area of Ibadan, Nigeria.

BACKGROUND

Tooth loss is an indication of the oral health of a population, and the possible effects of oral health on general health of the elders has been reported.

MATERIAL AND METHODS

A cross-sectional study was undertaken among 392 consenting elders in Idikan, Ibadan, Nigeria. Information on socio-demographic characteristics, causes and effects of tooth loss was obtained using a pretested semistructured questionnaire. After the interview, the elders were examined for the presence of tooth loss by a trained examiner.

RESULT

Mean (SD) age of the elders was 73.0 (9.2) years. One hundred and eighty-seven (47.7%) participants had ≥1 missing tooth, and 20 (5.1%) participants had complete edentulousness. The mean SD number of missing teeth was 5.9 (4.7) teeth. Age, level of education, monthly income and physical impairment were associated with mean (SD) number of missing teeth (P˂.05). Speech difficulty, appearance problems, chewing difficulty, feeling bereaved, mobility of adjacent teeth, halitosis and premature ageing were reported more by participants who had ˃16 missing teeth compared to those who had ≤16 teeth (P˂.05).

CONCLUSION

The mouth prevalence of tooth loss was 47.7%, and mean (SD) number of missing teeth was 5.9 (4.7) teeth. Age, level of education, monthly income and physical impairment were associated with number of missing teeth (P˂.05). Speech difficulty, appearance problem, chewing difficulty, feeling of bereavement, mobility of adjacent teeth, halitosis and premature ageing were associated with increasing number of missing teeth (P˂.05).

Periodontitis in patients with coronary artery disease: an 8-year follow-up

BACKGROUND

This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD-related death) during 8-year follow-up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls.

METHODS

In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 ± 8.9 years) and 121 controls (101 males and 20 females, mean age: 69 ± 9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow-up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register.

RESULTS

No significant differences were found among patients with CAD, with or without CAD-related endpoints at 8-year follow-up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls.

CONCLUSIONS

The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8-year follow-up. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD, in terms of endpoints including myocardial infarction, new revascularization procedure, and CAD-related death.

The impact of edentulism on oral and general health

An adequate dentition is of importance for well-being and life quality. Despite advances in preventive dentistry, edentulism is still a major public health problem worldwide. In this narrative review, we provide a perspective on the pathways that link oral to general health. A better understanding of disease indicators is necessary for establishing a solid strategy through an organized oral health care system to prevent and treat this morbid chronic condition.

Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association

A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.

Relationship between Aortic Atherosclerosis and Dental Loss in an Inner-City Population

Prior studies have suggested an association between atherosclerosis and periodontal disease, both of which are more prevalent in certain minority and economically disadvantaged groups. Few studies have addressed the relationship between cardiovascular disease and dentition among ethnically diverse populations. We studied 131 subjects (60% females, age 59 ± 15 years) who were referred for clinically indicated transesophageal echocardiography. Dental loss was more severe in patients with hypertension ( P < .001), diabetes ( P = .05), coronary artery disease ( P = .04), and calcium channel blocker use ( P = .04). On univariate analysis, maximal aortic intima—media thickness (MAIMT) was significantly correlated with dental loss ( r = .40; P < .001). Age was correlated with MAIMT ( R = .41; P < .001) and with dental loss ( r = .57; P < .001). On multivariate analysis, dental loss ( P = .03) and history of coronary artery disease ( P = .04) were independent predictors of MAIMT ( R 2 = .44). In this inner-city predominantly African American population, atherosclerosis and dental loss are age dependent and are interrelated independent of age.

Influence of oral health on febrile status in long-term hospitalized elderly patients

Many elderly patients have various health problems and are susceptible to recurrent fever. We examined the influence of oral health on the febrile status of 271 long-term hospitalized elderly patients over 1 year. In dentate patients, those with > or =20 teeth had a significantly higher risk for fever than those with 1-9 teeth; multivariate logistic regression analysis: odds ratio (OR)=5.44, 95% confidence interval (CI)=1.37-21.66. In edentate patients, those with moderate or much tongue plaque had a significantly higher risk for fever than those with no or slight tongue plaque; multivariate analysis: OR=5.14, 95% CI=1.77-14.88. These results suggest that oral health status related to febrile status differs between dentate and edentate patients in the elderly population.

Oral health and mortality risk from pneumonia in the elderly

Although poor oral health influences the occurrence of pulmonary infection in elderly people, it is unclear how the degree of oral health is linked to mortality from pulmonary infection. Therefore, we evaluated the relationship between oral health and four-year mortality from pneumonia in an elderly Japanese population. The study population consisted of 697 (277 males, 420 females) of the 1282 individuals who were 80 years old in 1997. Data on oral and systemic health were obtained by means of questionnaires, physical examinations, and laboratory blood tests. One hundred eight of the study persons died between 1998 and 2002. Of these, 22 deaths were due to pneumonia. The adjusted mortality due to pneumonia was 3.9 times higher in persons with 10 or more teeth with a probing depth exceeding 4 mm (periodontal pocket) than in those without periodontal pockets. Therefore, the increase in teeth with periodontal pockets in the elderly may be associated with increased mortality from pneumonia.

Assessment of the relationship between the mandibular cortex on panoramic radiographs and the risk of bone fracture and vascular disease in 80-year-olds

OBJECTIVES

The objective of this study was to assess cortical measurements on panoramic radiographs in 80-year-old subjects to predict bone fracture and vascular disease risks.

METHODS

The cortical width and shape (normal cortex, mildly to moderately eroded cortex, and severely eroded cortex) were evaluated on 659 panoramic radiographs obtained from 262 men and 397 women, all of whom were 80 years old. At baseline, a general medical examination, including heel bone density, was performed in all subjects. Fractures and vascular disease occurring within 5 years after the baseline examination were determined in 191 subjects and in 108 subjects who died within 5 years after the baseline examination.

RESULTS

There were significant correlations between heel bone density and cortical width (r = 0.435, P < .001) and shape (r = 0.231, P < .001). However, cortical measurements on panoramic radiographs were not significantly associated with the occurrence of fractures and vascular disease within 5 years after the baseline examination.

CONCLUSIONS

Among the elderly, cortical measurements on panoramic radiographs may be associated with bone mineral density and physical activity, but they are not useful markers for the subsequent occurrence of fractures and vascular disease.

Tooth loss and subsequent disability and mortality in old age

OBJECTIVES

To examine whether tooth loss at age 70 is associated with onset of disability at 5-, 10-, 15-, and 20-year follow-up and to mortality at 21-year follow-up.

SETTING

Community-based population in Copenhagen.

DESIGN

A baseline study of a random sample of 70-year-old people born in 1914 and follow-up 5, 10, 15, and 20 years later.

PARTICIPANTS

A total of 573 nondisabled individuals participated in the study of 70-year-olds in 1984, 460 participated in the 5-year follow-up, 292 in the 10-year follow-up, 150 in the 15-year follow-up, and 78 in the 20-year follow-up.

MEASUREMENTS

Data from interviews and a medical and oral examination. Oral health was measured according to number of teeth (0, 1-9, 10-19, > or = 20). Disability was measured using the Avlund Mob-H scale at age 75, 80, 85, and 90. Mortality data were obtained from the National Death Register.

RESULTS

Being edentulous or having one to nine teeth was associated with onset of disability at age 75 and 80. Health-related variables and education attenuated the associations between edentulism and onset of disability, although they remained marginally significant, whereas the association between having one to nine teeth and onset of disability remained unchanged and statistically significant at 10-year follow-up (odds ratio=3.02, 95% confidence interval (CI)=1.26-7.24). Persons who were edentulous at age 70 were at significantly higher risk of mortality 21 years later, also in the adjusted analysis (hazard ratio=1.26, 95% CI=1.03-1.55).

CONCLUSION

Tooth loss is independently associated with onset of disability and mortality in old age. The findings indicate that tooth loss may be an early indicator of accelerated aging.

Correlates of partial tooth loss and edentulism in the Brazilian elderly

BACKGROUND

In South American older adults the association between tooth loss and demographic, predisposing and enabling factors has not been determined. The purpose of this study was to evaluate the association between partial and complete tooth loss and demographic, predisposing, enabling and need factors, and quality of life variables in the Brazilian older adults.

METHODS

In this cross-sectional study, 5349 subjects aged 65-74 years were evaluated using conglomerate random sampling. Data collection included dental examinations and questionnaires evaluating demographic, predisposing, enabling and need factors, and quality of life variables. Multinomial logistic regression was carried out to evaluate correlates of tooth loss. The number of teeth was set as the outcome and categorized as: edentulous, subjects with 1-19 teeth, and subjects with 20 or more teeth.

RESULTS

Predisposing factors including age, female gender and schooling were independently associated with edentulism. Female gender was associated with partial tooth loss. The only enabling factor associated with edentulism was car ownership. Need factors were associated with edentulism and partial tooth loss. Edentulous subjects perceived the need for dental treatment less frequently. Quality of life factors were associated with partial tooth loss and edentulism. Subjects with 1-19 teeth and edentulous subjects were more likely to rate their chewing ability as not good. Edentulous subjects were more likely to rate their speech ability and their dental appearance as good.

CONCLUSIONS

The results indicate that tooth loss and edentulism were complex phenomena, with intricate predisposing, demographic, enabling and need factors playing a role.

Relationship between chewing ability and 4-year mortality in a cohort of 80-year-old Japanese people

OBJECTIVE

Poor oral health has been reported to be a risk indicator of mortality, however, few data are available regarding the relationship between chewing ability and mortality. We examined the relationship between self-assessed chewing ability and mortality in elderly subjects.

DESIGN

Prospective study.

SUBJECTS AND METHODS

Participating in the study were 697 people (277 males, 420 females) from 1282 individuals (80 years old) residing in Fukuoka Prefecture, Japan. Data on oral and systemic health status through questionnaires, accompanied by physical and laboratory blood examinations were obtained. Chewing ability was assessed based on the number of types of food each subject reported as able to chew by questionnaire.

RESULTS

A total of 108 subjects died between 1998 and 2002. Those with the lowest number of chewable foods were associated with higher risk of mortality than those with the ability to chew all of the 15 types of food surveyed [hazard ratio (HR) = 2.38, 95% confidence interval (95% CI) = 1.07-5.29], though other parameters including current smoking, low serum albumin, and poor physical health status were more significant. Further, reduced chewing ability of soft foods increased the risk (HR = 2.65, 95% CI = 1.20-5.87).

CONCLUSION

Chewing ability was associated with mortality in a population of 80-year-old community residents, and may be a predictor for survival rate.

Clinical significance and variation of the advanced calcified stylohyoid complex detected by panoramic radiographs among 80-year-old subjects

OBJECTIVES

To evaluate the clinical significance and variation of a calcified stylohyoid complex associated with advanced calcification as detected on panoramic radiographs among 80-year-old subjects.

METHODS

Panoramic radiographs of 659 patients (262 men and 397 women) and data of their general and dental health conditions were used for the evaluation of the relationship between a calcified stylohyoid complex and general health among 80-year-olds. This study was part of the 8020 Data Bank Survey, which was designed to collect the baseline data of general and dental health conditions in 80-year-old subjects. The morphology of the calcified stylohyoid complexes was allocated to one of 12 patterns. The lengths of the calcified stylohyoid complex were measured directly on the radiographs from the caudal margin of the tympanic plate to the tip of the styloid process.

RESULTS

All of the stylohyoid complexes from the 659 panoramic radiographs could be allocated to one of 12 morphological patterns, and some of their radiographic findings suggested calcification of the carotid artery and lymph nodes. In 80-year-old subjects, the average length of the calcified stylohyoid complexes was 36.7 mm, and ranged from 0.0 mm to 153.0 mm. There appeared to be correlations between the length of the calcified stylohyoid complex and serum calcium concentration and heel bone density, but not with the Community Periodontal Index (CPI).

CONCLUSIONS

Dentists should recognize the existence of morphological variation in calcified stylohyoid complexes, especially in length, apparent on panoramic radiographs of 80-year-old patients. In addition, the longer length of the calcified stylohyoid complexes in 80-year-old patients may be a predictor of bone density and high serum calcium concentration level. The findings from the present study may provide potentially life-saving information about elderly people.

Can the presence of carotid artery calcification on panoramic radiographs predict the risk of vascular diseases among 80-year-olds?

OBJECTIVE

The purpose of this study was to evaluate whether subsequent vascular diseases and related death could be predicted by the presence of carotid artery calcification detected on panoramic radiographs among elderly persons.

STUDY DESIGN

We evaluated 659 panoramic radiographs from 262 male and 397 female 80-year-old subjects and their general medical examination data to assess the relationship between the presence of carotid artery calcification and vascular disease risk at baseline examination. Of these subjects, the occurrence of vascular diseases within 5 years after baseline examination was examined in 191 subjects. Further, the causes of death were examined in 108 subjects who died within 5 years after baseline examination.

RESULTS

There was a significant difference in the history of past vascular diseases among subjects with and without carotid artery calcifications; however, no significant difference in the occurrence of subsequent vascular diseases was found among them. Further, there was no significant difference in the occurrence of vascular disease-related death within 5 years after baseline examination among subjects with and without carotid artery calcifications (P = 0.719).

CONCLUSION

Our results suggest that the presence of carotid artery calcifications on panoramic radiographs may be related to the history of past vascular diseases; however, this is not a useful marker for subsequent vascular diseases and related death among 80-year-olds.

The relationship between dietary intake and the number of teeth in elderly Japanese subjects

OBJECTIVE

This study used a precise weighing method to assess whether tooth loss was related to nutrient intake in elderly Japanese subjects.

MATERIAL AND METHODS

Fifty-seven subjects aged 74 years were randomly selected from a longitudinal interdisciplinary study of ageing. Complete 3-day food intake data were obtained by a precise weighing method. The dietary intakes of energy and nutrients were calculated based on the Standard Tables of Food Composition in Japan (5th ed.). A clinical evaluation of the number of teeth present was carried out. Multiple regression standardised coefficients for each nutrient was estimated based on a continuous scale adjusted for gender, smoking habits, and educational level. After dividing the subjects into two groups according to the number of teeth present (0-19, 20+), the difference in the intake of nutrients and the amount of food consumed per day was evaluated.

RESULTS

The number of teeth present had a significant relationship with the intake of several nutrients. In particular, total protein, animal protein, sodium, vitamin D, vitamin B1, vitamin B6, niacin, and pantothenic acid were significantly associated with the number of teeth present and with the two groups (0-19, 20+). The intake of vegetables and fish, shellfish, and their products was significantly lower among subjects with fewer teeth.

CONCLUSION

This study suggests that there was a significant relationship between nutrient intake, such as minerals and vitamins from food, and tooth loss.

Systemic effects of periodontal diseases

A number of studies suggest an association between periodontal disease and cardiovascular disease, pulmonary disease, diabetes,and pregnancy complications. Presently, the data must be regarded as preliminary. Additional large-scale longitudinal epidemiologic and interventional studies are necessary to validate these associations and to determine whether the associations are causal. The goal of this article is to review the history of this concept, describe the biologically plausible circumstances that may underlie these potential associations, and provide a summary of the published literature that supports or refutes them.

Relationship of number of remaining teeth to health-related quality of life in community-dwelling elderly

OBJECTIVE

The aim of this study was to evaluate the relationship between number of remaining teeth and health-related quality of life in community-dwelling elderly.

SUBJECTS

A total of 207 participants who were community-dwelling, 85 years of age. Data were from a population-based study of age-related general and oral health in Fukuoka Prefecture, Japan.

MEASUREMENTS

The Japanese version of the Short Form 36 Health Survey (SF-36).

RESULTS

The mental component score for the participants, from the SF-36, was higher than the Japanese national norm for those aged > or = 70 years. There were no significant differences in the mean of any scores on the SF-36 by having spouse, living with family, or education level. The mean of the SF-36 scores of physical functioning (PF) and of the physical component scores were significantly higher in the 85-year-old participants with > or = 20 teeth than in those with < or = 19 teeth (p < 0.05 and p < 0.01 respectively). In addition, a significant difference (p < 0.05) was observed between the mean of participants with > or = 20 teeth and those with < or = 19 teeth after adjustment for region where the participant lived, activities of daily living (ADL), and sex. The PF (p < 0.001), role-physical (p < 0.005), bodily pain (p < 0.001), vitality (p < 0.001), social functioning (p < 0.05), and physical component (p < 0.001) scores were significantly higher in participants with a good activities of daily living (ADL) assessment. However, ADL was not associated with the number of teeth.

CONCLUSIONS

The findings of the present study indicated that 85-year-old participants with > or = 20 teeth had better subjective physical health than those with < or = 19 teeth.

Dental Caries, Periodontal Disease, and Cardiac Arrhythmias in Community-Dwelling Older Persons Aged 80 and Older: Is There a Link?

OBJECTIVES

To examine whether caries or periodontitis is associated with cardiac arrhythmias in community-dwelling people aged 80 and older.

SETTING

Urban, community-based population in Stockholm, Sweden.

DESIGN

Cross-sectional.

PARTICIPANTS

Eligible persons were identified through the Kungsholmen Project, which is an ongoing, longitudinal, population-based study of the oldest old. The present study included 125 dentate individuals.

MEASUREMENTS

Data from interviews, a medical examination, and an oral examination. The assessment of cardiac arrhythmia was based on a clinical examination by a physician or the Stockholm Inpatient Register. Active root caries, active coronal caries, and periodontitis were assessed using previously defined National Institute of Dental and Craniofacial Research diagnostic criteria.

RESULTS

The primary finding of the multivariate logistic regression analysis was that persons with three or more active root caries lesions had more than twice the odds of cardiac arrhythmias than persons without active root caries. The results did not notably change after adjusting for age, medications that reduce saliva, and number of teeth. Persons with one to two active coronal caries lesions had 2.8 times higher odds (95% confidence interval=1.1-7.0) of arrhythmia than persons without active coronal caries, but there was no greater risk for persons with three or more coronal caries lesions. There was no association between periodontal disease and arrhythmia.

CONCLUSION

The findings indicate that there may be a link between active root caries and cardiac arrhythmias in the oldest old. Nevertheless, although a biological pathway is not obvious, it is plausible that both are simply markers of declining general health. The results suggest the need for further study of these relationships.

Evaluation of the relationship between periapical lesions/sclerotic bone and general bone density as a possible gauge of general health among 80-year-olds

OBJECTIVES

To evaluate the incidence among 80-year-olds of periapical lesions as detected on panoramic radiographs and to determine the relationship between sclerotic bone around the periapical lesions to heel bone density, body height, and hand-grip strength.

STUDY DESIGN

Six hundred fifty-nine panoramic radiographs (262 males, 397 females), obtained from 80-year-old residents of Fukuoka Prefecture, Japan, were used for evaluation of periapical lesions. These findings were correlated with physical examination results to determine the relationship to general health.

RESULTS

Of 659 panoramic radiographs, 31 (5%) were noted to have periapical lesions. Average size of the 31 periapical lesions was 6.1 +/- 2.2 mm. Of the 31 periapical lesions, 21 (68%) were accompanied by linear or diffuse types of sclerotic bone. Of the 21 sclerotic bones, 10 (48%) were of a linear type of sclerotic bone and 11 (52%) of a diffuse type of sclerotic bone. Of the 11 diffuse types of sclerotic bone, 10 (91%) were in the mandible and 1 (9%) in the maxilla. Periapical lesions in the mandible were more frequently accompanied by a diffuse type of sclerotic bone than those in the maxilla (P < .01). The hand-grip strength of those having periapical lesions, accompanied by a diffuse type of sclerotic bone, was stronger than those having no periapical lesions (P < .01) and those accompanied by a linear type of sclerotic bone (P < .03). However, there was no relationship between presence of sclerotic bone and heel bone density or body height.

CONCLUSIONS

Periapical lesions accompanied by a diffuse type of sclerotic bone were more frequently seen in the mandible of 80-year-olds. To evaluate the clinical significance of sclerotic bone around periapical lesions in 80-year-olds, further study to evaluate the significance of endodontic treatment needs to be done.

Endothelial Dysfunction in Patients With Chronic Periodontitis and Its Improvement After Initial Periodontal Therapy

BACKGROUND

Recent epidemiological data suggested that there is a relationship between periodontal health and atherosclerotic coronary heart disease. Although hypothetical models were proposed, the exact mechanism of this association has not been clarified. The aim of this study is to investigate whether there is an endothelial dysfunction in patients with chronic periodontitis and, if present, whether recovery is possible with therapy.

METHODS

The study groups consisted of 28 patients (mean age: 45.5 +/- 8.6 years) with chronic periodontitis and without any atherosclerotic vascular disease, and 26 healthy controls (mean age: 43.7 +/- 6.8 years). Cardiovascular risk factors were investigated in both groups. Brachial artery responses to reactive hyperemia (endothelium-dependent dilatation [EDD]) and sublingual nitroglycerin (endothelium-independent dilatation [EID]) were measured using high-resolution vascular ultrasound in both groups. Measurements were taken before and after initial periodontal therapy in the periodontal patients.

RESULTS

There was no significant difference between the groups with regard to cardiovascular risk factors. In the baseline measurements, EDD and EID were significantly impaired in patients with chronic periodontitis when compared with the controls (8.4% +/- 4.0% versus 19.4% +/- 8.1%, P<0.0001; 13.3% +/- 6.3% versus 29.5% +/- 10.0%, P<0.0001 for EDD and EID, respectively). After non-surgical periodontal therapy, EDD and EID improved significantly (from 8.4% +/- 4.0% to 17.7% +/- 5.7%, P<0.0001; and from 13.3% +/- 6.3% to 24.9% +/- 7.3%, P<0.0001 for FMD and EID, respectively). The EDD and EID changes in the controls were insignificant.

CONCLUSION

This study showed that endothelial functions were impaired in patients with chronic periodontitis and that they improve following initial periodontal therapy.

Oral health, atherosclerosis, and cardiovascular disease

During the last two decades, there has been an increasing interest in the impact of oral health on atherosclerosis and subsequent cardiovascular disease (CVD). The advent of the inflammation paradigm in coronary pathogenesis stimulated research in chronic infections caused by a variety of micro-organisms-such as Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus-as well as dental pathogens, since these chronic infections are thought to be involved in the etiopathogenesis of CVD by releasing cytokines and other pro-inflammatory mediators (e.g., C-reactive protein [CRP], tumor necrosis factor [TNF-alpha]) that may initiate a cascade of biochemical reactions and cause endothelial damage and facilitate cholesterol plaque attachment. Yet, due to the multi-factorial nature of dental infection and CVD, confirming a causal association is difficult, and the published results are conflicting. The main deficit in the majority of these studies has been the inadequate control of numerous confounding factors, leading to an overestimation and the imprecise measurement of the predictor or overadjustment of the confounding variables, resulting in underestimation of the risks. A meta-analysis of prospective and retrospective follow-up studies has shown that periodontal disease may increase the risk of CVD by approximately 20% (95% confidence interval [CI], 1.08-1.32). Similarly, the reported risk ratio between periodontal disease and stroke is even stronger, varying from 2.85 (CI 1.78-4.56) to 1.74 (CI 1.08-2.81). The association between peripheral vascular disease and oral health parameters has been explored in only two studies, and the resultant relative risks among individuals with periodontitis were 1.41 (CI 1.12-1.77) and 2.27 (CI 1.32-3.90), respectively. Overall, it appears that periodontal disease may indeed contribute to the pathogenesis of cardiovascular disease, although the statistical effect size is small.

Relationship of periodontal disease and tooth loss to prevalence of coronary heart disease

BACKGROUND

Studies relating periodontal disease to coronary heart disease (CHD) have provided equivocal results using tooth loss and/or clinical signs of periodontal disease as measures of periodontal exposure.

METHODS

The purpose of this cross-sectional study was to evaluate the relationship of tooth loss and periodontitis to prevalent CHD at the Atherosclerosis Risk in Communities (ARIC) visit 4 using both tooth loss and clinical signs of disease in a population-based sample of 8,363 men and women aged 52 to 75 years from four U.S. communities. Each subject participated in a complete periodontal examination, assessment of missing teeth, assessment of prevalent CHD, and a number of laboratory tests and questionnaires. High attachment loss was defined as > or = 10% of sites with attachment loss > 3 mm and high tooth loss was defined as fewer than 17 remaining teeth.

RESULTS

Individuals with both high attachment loss and high tooth loss (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1 to 2.0) and edentulous individuals (OR 1.8, CI 1.4 to 2.4) had elevated odds of prevalent CHD compared to individuals with low attachment loss and low tooth loss, while controlling for a number of traditional risk factors for CHD.

CONCLUSIONS

These results suggest that tooth loss and periodontal disease are associated with prevalent CHD, but only when both are present. The weaker relationships between periodontal disease and CHD that have been found among older adults may be due to older adults having fewer teeth. Future longitudinal studies should be designed to ascertain the cause of tooth loss during follow-up.

Relationship Between Electrocardiographic Abnormalities and Periodontal Disease: The Hisayama Study

BACKGROUND

Recent studies have suggested a relationship between periodontitis and cardiovascular disease (CVD). This study investigated the relationship between periodontitis and electrocardiographic (ECG) abnormalities, which are known predictors of CVD.

METHODS

We examined the periodontal status of 1,111 residents of Hisayama Town, Fukuoka, Japan. Nine hundred fifty-seven (957) subjects (374 males, 583 females) with > or = 10 teeth and without a medical history of CVD were included in the analysis. Probing depth (PD) and clinical attachment level (CAL) were measured on two randomly selected quadrants, one maxillary and one mandibular. A 12-lead ECG was recorded using a standard electrocardiograph. ECG abnormalities included left ventricular hypertrophy (Minnesota code 3-1) and ST depression (4-1, 2, 3). The relation of periodontal condition and ECG abnormalities was assessed with logistic regression analysis.

RESULTS

Univariate analysis revealed that mean probing depth, mean attachment loss, number of teeth, and plaque index were significantly associated with ECG abnormalities, as well as with known risk factors of CVD. In multivariate analysis, the subjects with deep pockets (mean probing depth > or = 2 mm) had an increased risk for ECG abnormalities (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.01 to 2.50) compared to the subjects with mean PD < 2 mm. Subjects with severe attachment loss (mean CAL > or = 2.5 mm) had also significant risk for ECG abnormalities (OR = 1.7; 95% CI = 1.07 to 2.67) compared to those whose mean CAL was < 2.5 mm.

CONCLUSION

This study clearly shows the relationship between periodontitis and ECG abnormalities, which are important predictors of CVD.

Edentulism and nutritional status in a biracial sample of well-functioning, community-dwelling elderly: the health, aging, and body composition study

BACKGROUND

Edentulism may affect dietary intake in older adults, but the relation between edentulism and nutritional status is not completely understood.

OBJECTIVE

The present study examined whether edentulism is associated with nutritional status and whether there is an interaction between race and edentulism on nutritional status among well-functioning, community-dwelling elderly.

DESIGN

The study cohort included 3075 elderly aged 70-79 y (52% women, 42% black) in the Health, Aging, and Body Composition Study. Dietary intake, anthropometric variables, weight change, and serum albumin and lipid concentrations were compared between edentate and dentate participants by the use of multiple linear and logistic regressions.

RESULTS

Edentulism was not associated with total energy or food intake but was associated with the food groups consumed, particularly fat, micronutrients, and hard-to-chew foods. Edentulism was more strongly linked to dietary intake in whites than in blacks. Unlike black edentate elderly, white edentate elderly consumed significantly lower energy-adjusted amounts of vitamin A and beta-carotene, higher amounts of energy-adjusted total and saturated fat and cholesterol, and higher percentages of energy from fat than did white dentate elderly. Anthropometry and biochemical indexes were not significantly different by edentulism status in both races. Edentulism was associated with weight gains of >5% in 1 y in both races.

CONCLUSIONS

Edentulism was associated with differences in the nutritional status of well-functioning, community-dwelling elderly, more so in whites than blacks. Edentate elders may benefit from dental, medical, and nutrition interventions targeted to addressing these findings.

Correlation study on oral health and electrocardiogram abnormalities

The purpose of this study was to investigate the association between periodontal conditions and electrocardiogram test results that were obtained to screen for coronary heart disease risk factors. The present study included a total of 578 subjects who underwent annual medical check-ups at the Total Health Care Center in Otsu, Shiga Prefecture, Japan. To calculate the odds ratios for the electromyography abnormalities, we performed a logistic regression analysis for the oral examination, electrocardiogram, and blood analysis data. The crude odds ratio was obtained by a logistic regression analysis of age, sex, number of missing teeth, number of filled teeth, simplified oral hygiene index, community periodontal index, and blood analysis factors and results indicated there was a statistically significant correlation with the prevalence of electrocardiogram abnormalities. However, electrocardiogram abnormalities have a strong correlation with demographic factors such as sex and age. Therefore the experimental factors representing oral status were reexamined after the odds ratios were adjusted for age and sex. As a result of this adjustment, the new odds ratios that were determined indicated that there were no correlations between the oral factors and the prevalence of electrocardiogram abnormalities.

Evaluation of calcified carotid artery atheromas detected by panoramic radiograph among 80-year-olds

OBJECTIVE

To evaluate the incidence among 80-year-olds of calcified carotid artery atheromas (CCAAs) as detected on panoramic radiographs. The relationship between CCAAs and general and oral health was also evaluated.

STUDY DESIGN

Six hundred and fifty-nine panoramic radiographs (262 males, 397 females), obtained from 80-year-old residents of Fukuoka Prefecture, Japan, were used for evaluation of CCAAs.

RESULTS

Of 659 panoramic radiographs, 33 (5%) were noted to have CCAAs. These appeared as a radiopaque nodular mass or masses adjacent to or just below the intervertebral space between C3 and C4. CCAAs were found in 8 males and 25 females. There were marginally significant differences between males and females in CCAAs (P = 0.06). Seventy-four percent of CCAAs were detected in the right side. There appeared to be very little relationship between CCAAs and general and oral health.

CONCLUSIONS

The results of this study gives further support to the idea of using panoramic radiographs to detect CCAAs. Therefore, we feel that panoramic radiographs should be evaluated not only for pathosis of the teeth and jaws, but also for other incidental findings, especially in the soft-tissue region of the neck. The findings from this study provide potentially life-saving information especially for those elderly people who are at risk for stroke.

Oral health and health behavior in patients referred for open-heart surgery

OBJECTIVE

Little is known about the dental health and health behavior of patients referred for open-heart surgery because of severe heart disease. Yet, coronary atherosclerosis has been suggested to be an inflammatory disease in which chronic dental infections may trigger pathogenic mechanisms in the walls of arteries. In epidemiological studies periodontal disease in particular has been linked with coronary heart disease (CHD).

STUDY DESIGN

We set out to investigate by means of clinical examination, x-ray, and questionnaire the oral health status, health-related behavior, and conceptions of 256 CHD patients referred for open-heart surgery in the Kuopio University Hospital. The patients' heart disease was New York Heart Association grades II-IV. For comparison, 250 age- and sex-matched non-CHD patients were also studied. Differences between groups were analyzed conventionally and with the Total Dental Index (TDI), which uses linear modeling and logistic regression analyses to summarize periodontal factors and other signs of oral infections. We expected to find neglected dental care and worse oral health situation among the CHD patients.

RESULTS

Edentulousness was seen in 35% of the CHD group and in 15% of the non-CHD group (P < .001). The CHD group had significantly lower number of teeth (8.8 +/- 9.1) than the non-CHD group (17 +/- 10.5; P < .001). No dental appointment in the past 10 years was reported in 66% of the CHD patients and 35% of the non-CHD patients. Forty-nine percent of the CHD group and 69% of the non-CHD group had had a dental visit within the past 2 years (P < .001). Daily tooth brushing was reported by 46% of the CHD group and 56% of the non-CHD group (P < .05). Only 2% of the CHD group and 8% of the non-CHD group flossed daily (P < .001). TDI scores were significantly higher in the edentulous than in the dentate study groups (P < .001), but no difference was observed between CHD and non-CHD patients of the same dentate or edentulous status. Mean TDI score was 3.2 +/- 0.8 in edentulous CHD patients and 3.1 +/- 0.4 in edentulous non-CHD patients; the scores in the dentate patients were 2.5 +/- 0.9 in the CHD group and 2.4 +/- 2.0 in the non-CHD group. The TDI score appeared almost significant a predictor of CHD when used as a dependent variable in logistic regression analysis (P = .08).

CONCLUSION

Worse oral health status and less satisfactory oral health behavior were observed in the CHD patients than among the cardiologically healthy.