Anthropology: the earliest toothless hominin skull

The site of Dmanisi in the Eurasian republic of Georgia has yielded striking hominin, faunal and archaeological material as evidence for the presence of early Homo outside Africa 1.77 million years ago, documenting an important episode in human evolution. Here we describe a beautifully preserved skull and jawbone from a Dmanisi hominin of this period who had lost all but one tooth several years before death. This specimen not only represents the earliest case of severe masticatory impairment in the hominin fossil record to be discovered so far, but also raises questions about alternative subsistence strategies in early Homo.

Five-year incidence of tooth loss in Iowans aged 65 and older

The prevalence of missing teeth has been described for US adults, but little is known about the incidence of tooth loss in any segment of the population. This study investigated the 5-yr incidence of tooth loss in a random sample of Iowans aged 65 yr and older residing in two rural counties. These people had an average of 20 teeth at baseline and approximately 40% lost at least one tooth in the subsequent 5 yr. The incidence of tooth loss was highest for mandibular molars and lowest for mandibular canines. Men were more likely than women to lose teeth. Although we were able to identify a number of statistically significant potential risk factors for tooth loss, the multivariate models that incorporated all these factors were not good predictors of which people were at highest risk for tooth loss.

Survival characteristics of periodontally-involved teeth: a 40-year study

Four hundred and fifty-five teeth that were judged clinically to have a questionable prognosis were observed over a 40-year span in 166 patients in a private practice. Therapy initially was debridement with oral hygiene instruction, followed by flap curettage procedures and preventive maintenance recall therapy. An assessment of compliance based on oral hygiene and recall attendance was also performed. A total of 55 (12%) teeth were lost with an average survival rate of 8.8 years prior to extraction. No teeth were lost during the first 2 years of observation. The majority of extracted teeth were maxillary second molars (38.2%), followed by maxillary first molars (25.5%), and mandibular second molars (16.4%). Tooth loss patterns appeared to be bilaterally symmetrical, with 51% of teeth lost in the right quadrants and 49% lost in the left quadrants. Indications for extraction were primarily periodontal abscesses. Teeth that were considered to have a very questionable prognosis have been retained for many years after therapy, supportive treatment, and patient compliance with recall attendance.

Osteoclast diseases and dental abnormalities

Tooth eruption depends on the presence of osteoclasts to create an eruption pathway through the alveolar bone. In diseases where osteoclast formation, or function is reduced, such as the various types of osteopetrosis, tooth eruption is affected. Diseases in which osteoclast formation or activity is increased, such as familiar expansile osteolysis and Paget's disease, are associated with dental abnormalities such as root resorption and premature tooth loss. Less is known about the origin of the dental problems in these conditions as there are no rodent models of these diseases as yet. In this short review, the genes currently known to be mutated in human osteoclast diseases will be reviewed and, where known, the effect of osteoclast dysfunction on dental development described. It will focus on human conditions and only mention rodent disease where no clear data in the human are available.

Size of the mandibular jaw angle related to age, tooth retention and gender

The size of the gonial angle was measured in cephalograms of 431 adults attending the Department of Prosthodontics, School of Dentistry, University of Bergen, Norway. The purpose of the work was to conduct a study of the variables often related to the development of the size of the gonial angle, i.e. age, degree of tooth retention, and gender. Descriptive data showed that the edentulous participants had the largest mean angle, the participants in possession of all teeth had the smallest angle, and the partially dentate participants had a jaw angle size between that of the aforementioned groups. Preliminary results of the analysis (ANOVA) showed that the number of teeth had a decisive influence on the size of the gonial angle. The correlation coefficients between size of the gonial angle and age showed that age explained approximately 8-16% of the variation of the angle through its relation with age. Sex differences in age and size of the gonial angle were not statistically significant in any of the three tooth retention categories. Future multiple regression analysis may explain a greater part of the variation of the angle if the analysis is carried out in separate age groups of the three categories.

Periodontitis and Tooth Loss Have Negative Systemic Impact on Circulating Progenitor Cell Levels: A Clinical Study

The aim of the present study was to investigate the association and impact of periodontitis and tooth loss on a subtype of endothelial progenitor cell (EPC) levels (CD133+/KDR+). Furthermore, the objective was to determine if the periodontal status influenced CD133+/KDR+ levels. In all, 88 patients with periodontitis and 79 healthy controls (HCs) were enrolled in the study. Enrolled patients were examined and characterized by clinical and blood sample analysis. Spearman's correlation test was applied in order to assess the interdependence between CD133+/KDR+ levels and all periodontal parameters. In order to estimate a statistically significant trend (p-trend) for ordered CD133++/KDR+ quartiles, the Jonckheere-Terpstra test was applied for all variables. Patients in the periodontitis group presented significantly lower CD133+/KDR+ levels (66.4 (45.5-269.6 cells/µL)) compared to the HC group (76.7 (24.3-313.2 cells/µL), p < 0.001). Lower CD133+/KDR+ levels negatively correlated with C-reactive protein (CRP), with the number of teeth, and with all periodontal parameters (p < 0.001). Moreover, there was a proportional increase in CD133+/KDR+ levels with a progressive increase in number of teeth (p-trend < 0.001), while there was a proportional decrease in CD133+/KDR+ levels with a proportional increase in clinical attachment level (CAL, p-trend = 0.003), probing depth (PD, p-trend = 0.007), and bleeding sites (bleeding on probing (BOP), p-trend < 0.001) as an extent measure of periodontitis. This study demonstrated that patients with periodontitis presented significantly lower CD133+/KDR+ levels compared to HCs. Moreover, all patients presented an increase in the CD133+/KDR+ EPC levels with an extended level of periodontitis and tooth loss.

Influence of tooth-loss and concomitant masticatory alterations on cholinergic neurons in rats: immunohistochemical and biochemical studies

The influence of tooth loss on the viability of cholinergic neurons was examined in rats. At 25th postnatal week, rats were divided into the three groups; a control group fed a solid diet, a soft diet group fed a powder diet and a molar crown-less group in which all molar crowns were removed and the powder diet was given. At 15 and 35 weeks post-treatment, the number of choline acetyltransferase (ChAT)-positive neurons in the nucleus of the diagonal band/medial septal nucleus (NDB/MS) was significantly smaller in the molar crown-less group than in the control group (P < 0.01). This was not the case in the pedunculopontine tegmental nucleus or (PPT) or in the trigeminal motor nucleus. Biochemical assay showed no statistically significant differences in choline concentrations in the hippocampus between the control and the molar crown-less group both at 15 and at 35 weeks post-treatment. Nevertheless, acetylcholine (ACh) concentration in the hippocampus of the molar crown-less group was significantly lower than that of the control group at 15 weeks post-treatment (P < 0.05). Taken together, a decrease of oral sensory information may have caused a reduction in the number of ChAT-positive neurons selectively in NDB/MS, which in turn caused a decline of ACh concentrations in the hippocampus.

Factors affecting degeneration in human temporomandibular joints as assessed histologically

The influence of sex, age, tooth loss, and articular disc position on temporomandibular joint (TMJ) degeneration was evaluated in specimens collected at autopsy from 15 women and 38 men ranging in age from 15 to 92 yr. The position of the articular discs was classified as normal or abnormal, tooth loss was both counted and categorized. Degenerative changes of the articular tissues were assessed histologically and quantified, taking into account both the severity of structural alterations and their extension along the articular surface. This was recorded separately in the condyle, disc, and temporal component, three latero-medial joint regions, and putative load-bearing and non-load-bearing surfaces. Analysis of covariance with repeated measures served for testing contributing factors. It showed that the effects of sex and the number of missing teeth were insignificant, whereas age up to about 55-60 yr and reduction of dental arch length proved to be the most important factors. Load-bearing seemed to play a significant role mainly at younger ages, and the effect of disc position was significant, when internal derangement was combined with reduction of dental arch length. Thus, rising severity of TMJ degenerative changes appears to be associated primarily with increasing age. In addition, it may also depend on mechanical factors, in particular loss of molar support and, to a minor degree, abnormal disc position.

Six-year progression of destructive periodontal disease in 2 subgroups of elderly Chinese

Two groups of elderly chinese were selected from a large epidemiological sample on the basis of a low ("best" group) or a high ("worst" group) number of sites with attachment loss levels > or = 6 mm and/or pocket depth > or = 4 mm and at least 16 teeth present. Six years later the patients were clinically reexamined and the subgingival microflora was assessed. This paper presents the clinical characteristics of destructive periodontal disease progression among the two subgroups. The "best" group lost an average of 1.8 teeth, contrasting the average loss of 5.3 teeth among the "worst" group. Virtually all teeth lost among the "worst" group had a baseline attachment loss level > or = 4 mm, in contrast to 48% among the "best" group. While dental caries could be identified as a cause of tooth loss in both groups, the excess tooth loss among the "worst" group seems attributable to periodontal destruction. The average of 1.21 mm attachment/site lost among the "best" group was not statistically significantly different from the 1.36 mm/site lost among the "worst" group during the 6 years. Individual mean losses of attachment ranged from a gain of 0.03 mm to a loss of 3.19 mm. An attachment loss > or = 2 mm at a site was highly positively associated with a high initial attachment loss level (> or = 4 mm) at that site among the "best" group, whereas a highly negative association was seen among the "worst" group.(ABSTRACT TRUNCATED AT 250 WORDS)

Progression of periodontal disease in patients with mild to moderate adult periodontitis

The aim of the present study was to determine the progression rate of periodontal disease in patients treated for localized or generalized mild to moderate adult periodontitis. 52 patients with a mean age of 53.7 years (S.D. 12.6 years) were instructed in optimal home care procedures and exposed to initial periodontal therapy, before reconstructive therapy was initiated. Following completion of the prosthetic procedures, supportive therapy was offered to a limited extent and maintenance visits were irregularly scheduled corresponding to traditional dental care. Clinical periodontal parameters from 4 sites per tooth were assessed at the initial examination, at the time of reevaluation after initial therapy and at the re-examination after 8-years. Full sets of intraoral radiographs from the initial and the 8-year re-examination were analyzed with respect to changes in the radiographic alveolar bone height as a % of the total tooth length. As the result of the home care instructions, the mean plaque index (plaque control record) amounted to 21% at the end of initial periodontal therapy. 8 years later, the re-examination revealed a mean plaque index of 49% and a mean gingival bleeding index of 24%. At the initial examination, the 52 patients presented with an average of 18.7 teeth. During treatment, 26 teeth were sacrificed and 19 teeth were lost over the 8 years of supportive therapy. Bicuspids were the most frequent teeth to be lost over the observation period. As a result of initial therapy, the mean pocket probing depths decreased significantly. However, after 8 years, only minor differences were found when compared to the initial examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Number of teeth and residual alveolar ridge height in subjects with a history of self-reported osteoporotic fractures

The purpose of this case-control study was to determine if elderly subjects with a history of osteoporotic fractures have fewer teeth and greater residual ridge resorption than subjects without such fractures. Patients older than 60 with a panoramic radiograph were invited to a phone interview. Information was obtained regarding fracture history, smoking, and hormone replacement therapy (HRT). The number of teeth was obtained from the panoramic radiograph. The residual ridge height of the edentulous mandible was measured at the site of the mental foramen. Multiple regression models were used to assess the association between fracture status and number of teeth or residual ridge height (controlling for age, gender, HRT, smoking, height and weight). Cases (n=93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n=394) were individuals reporting traumatic fractures (n=105) or no fractures (n=289). Fracture status in this population affect neither the number of teeth nor the residual ridge height. In the regression model, the variables that had a statistically-significant effect on the number of teeth were age (p<0.0001) and smoking (p<0.0001). There was a dose-effect of smoking on the number of teeth. In the regression model, the variables that had a significantly-significant on residual ridge height (n=95 edentulous subjects) were age and gender. Our conclusion was that in elderly dental-school patients the number of teeth and residual ridge height were not influenced by fracture status. Age and smoking had the most influence; there was no effect from HRT. The clinical implication is that a history of osteoporotic fractures is not an important cause for tooth loss and residual ridge resorption in an elderly dental-school population.

Loss of space and changes in the dental arch after premature loss of the lower primary molar: a longitudinal study

The purpose of the study was to evaluate the space changes, dental arch width, arch length and arch perimeter, after the unilateral extraction of lower first primary molar in the mixed dentition period. A longitudinal study was conducted among forty children in the age group of 6-9 years, who reported for extraction of lower first primary molar in the department of Pedodontics, Govt. Dental College, Trivandrum. Study models were made from alginate impression taken before extraction and after extraction at the periodical intervals of two months, four months, six months and eight months. The mesiodistal width of lower first primary molar of the non-extracted side was taken as the control. The results of the study showed statistically significant space loss in the extraction side ( P value < 0.01) and no significant space loss in the control side (P value > 0.05). The rate of loss was greatest in the first four months. The arch width, arch length and arch perimeter had no significant change from initial to eight months follow up. The present study challenges the use of a space maintenance under the circumstances of premature loss of mandibular primary molar for preventing space loss.

Periodontopathogens in elderly Chinese with different periodontal disease experience

If an etiological relationship exists between destructive periodontal disease and putative periodontopathogens, they would be expected to have a very low prevalence in periodontally healthy elderly persons. To test this hypothesis, 2 subgroups of elderly, rural Chinese (a periodontally "best" and a "worst" group, each comprising 15 persons) were identified in 1990 from a cohort aged 55-69 years, examined in 1984. Assessment of changes in periodontal status over the 6-year period were possible by comparing detailed clinical recordings performed by the same examinator. Subgingival microbial samples were taken at the mesial aspects of an upper central incisor and a lower canine and examined for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia group, Prevotella melaninogenica group, Capnocytophaga, Selenomonas, Campylobacter rectus as well as predominant Streptococcus and Actinomyces species. During the 6 years prior to microbiological sampling, persons in the "best" group had lost an average of 1.21 +/- 0.48 mm attachment, while persons in the "worst" group had lost an average of 1.60 +/- 0.94 mm. The latter group had lost 53.3 teeth, predominantly for periodontal reasons, in contrast to 1.8 teeth lost in the "best" group. "Best" persons did not differ from "worst" persons with respect to the occurrence of the putative periopathogens, total viable count, and total streptococcal and Actinomyces recovery. Similarly, sites which had experienced an attachment loss > or = 2 mm during the 6-year period did not differ microbiologically from sites with less attachment loss. It is concluded that subgingival microbial characterization does not allow for a distinction between elderly individuals with markedly different periodontal disease experiences.

Clinical and immunological characteristics of patients with rheumatoid arthritis and periodontal disease

Various clinical and immunological parameters were determined in patients with RA and patients with adult periodontitis. There were no significant differences between the two groups with regard to the number of missing teeth, although pocket depths and gingival inflammation scores were significantly increased in the periodontitis group (p less than 0.05). Salivary IgM levels were below the minimum detectable level in both groups, and no significant differences were evident between the two groups with regard to salivary IgG and IgA levels. However, serum IgG, IgA and IgM levels in RA patients were significantly higher than in periodontitis patients (p less than 0.05), indicating enhanced humoral immunity. The present findings suggest that RA patients are not a risk group for advanced periodontal problems in comparison with age- and sex-matched systemically healthy controls.

Dental effects of diet and coca-leaf chewing on two prehistoric cultures of northern Chile

Two ancient cultures of northern Chile, the Chinchorro (9000-3500 BP) and the Maitas Chiribaya (850-700 BP) were examined for dental pathology in search of possible correlations between dental health, diet, and the cultural practice of coca-leaf chewing. The Chinchorro occupied the river mouth of the Azapa valley, subsisting almost exclusively on a maritime economy. The Maitas Chiribaya, descendants of migrant highlanders, had a rather well-developed agricultural subsistence base. The Chinchorro demonstrated extreme attrition rates and a correspondingly high frequency of periapical abscesses. They were essentially caries-free and enjoyed a moderate antemortem tooth loss frequency. The Maitas Chiribaya suffered light attrition; a high caries frequency, especially at the cementoenamel junction of crown and root, and a remarkably high antemortem tooth loss frequency. The cultural practice of coca-leaf chewing is implicated in the excessive posterior edentulism of the Maitas Chiribaya.

Associated factors of tooth wear in southern Thailand

The purpose of this study was to evaluate the possible risk factors connected with tooth wear. Using the Tooth Wear Index (TWI) and the charting of pre-disposing factors tooth surface loss was recorded in 506 patients, of the Dental Hospital, Prince of Songkla University. We found that age, sex, number of tooth loss, frequency of alcohol, sour fruit and carbonate intake were significant risk factors. Regarding the tooth position, the first molar showed the greatest degree of wear, while the canine and premolar showed the least, respectively. The occlusal surface showed the greatest wear and the cervical, lingual and buccal surfaces showed the least, respectively.

The Bronze Age burials from Cova Dels Blaus (Vall d′Uixó, Castelló, Spain): An approach to palaeodietary reconstruction through dental pathology, occlusal wear and buccal microwear patterns

This paper reports a palaeodietary investigation of the human remains found in the collective Bronze Age burial cave from Vall d'Uixó (Castelló, Spain). Dental pathology, tooth wear as well as buccal dental microwear were analysed. Percentages of dental pathologies were compared with Chalcolithic and Bronze Age sites from the same territory. Dental caries, ante-mortem tooth loss, periodontal disease and abscess frequencies indicate a diet rich in carbohydrate foods. However, dental calculus percentages and macroscopic wear patterns suggest a diet not exclusively relying on agricultural resources. In addition, buccal dental microwear density and length by orientation recorded on micrographs using a scanning electron microscope showed inter-group differences with regard to carnivorous hunter-gatherers and farming populations related to the amount of abrasives in the diet that could correspond to a different dependence on agricultural resources or food preparation technology.

Poor Oral Health and Inflammatory, Hemostatic, and Cardiac Biomarkers in Older Age: Results From Two Studies in the UK and USA

BACKGROUND

We examined the association of objective and subjective oral health markers with inflammatory, hemostatic, and cardiac biomarkers in older age.

METHODS

Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising British men aged 71-92 years (n = 2,147), and the Health, Aging and Body Composition (HABC) Study comprising American men and women aged 71-80 years (n = 3,075). Oral health markers included periodontal disease, tooth count, dry mouth. Inflammatory biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6) in both studies, and tissue plasminogen activator (t-PA), von Willebrand Factor (vWF), fibrin D-dimer, high-sensitivity Troponin T (hsTnT), and N-terminal pro-brain natriuretic peptide (NTproBNP) only in the BRHS.

RESULTS

In both studies, tooth loss, was associated with the top tertile of CRP-odds ratios (ORs) (95% confidence interval [CI]) are 1.31 (1.02-1.68) in BRHS; and 1.40 (1.13-1.75) in the HABC Study, after adjusting for confounders. In the HABC Study, cumulative (≥3) oral health problems were associated with higher levels of CRP (OR [95% CI] =1.42 [1.01-1.99]). In the BRHS, complete and partial tooth loss was associated with hemostatic factors, in particular with the top tertile of fibrin D-dimer (OR [95% CI] = 1.64 [1.16-2.30] and 1.37 [1.05-1.77], respectively). Tooth loss and periodontal disease were associated with increased levels of hsTnT.

CONCLUSIONS

Poor oral health in older age, particularly tooth loss, was consistently associated with some inflammatory, hemostatic, and cardiac biomarkers. Prospective studies and intervention trials could help understand better if poor oral health is causally linked to inflammatory, hemostatic, and cardiac biomarkers.

Tooth loss and general quality of life in dentate adults from Southern Brazil

PURPOSE

This study aimed to estimate the association between the number of teeth and general quality of life in adults.

METHODS

A population-based study was conducted with 1720 individuals aged 20-59 years residing in Florianópolis, Brazil, in 2009. Data were collected at participants' households using a structured questionnaire. In 2012, a second wave was undertaken with 1222 individuals. Oral examinations were performed for number of teeth, prevalence of functional dentition (≥21 natural teeth), and shortened dental arch (SDA), which were considered the main exposures. General quality of life was the outcome and was assessed with the WHO Abbreviated Instrument for Quality of Life (WHOQOL-BREF). Covariates included sociodemographic factors, health-related behaviors, and chronic diseases. Multivariable linear regression models were performed to test the associations between the main exposures and the outcome adjusted for covariates.

RESULTS

In 2012, 1222 individuals participated in the study (response rate = 71.1%). Having more teeth was associated with greater scores on physical domain of the WHOQOL-BREF [β = 0.24 (95% CI 0.01; 0.46)] after adjustment for covariates. Absence of functional dentition was associated with lower scores on the physical domain [β = -3.94 (95% CI -7.40; -0.48)] in the adjusted analysis. There was no association between both SDA definitions and the domains of general quality of life.

CONCLUSIONS

Oral health as measured by tooth loss was associated with negative impacts on general quality of life assessed by the WHOQOL-BREF. There was a lack of evidence that SDA is a condition that negatively affects general quality of life.

Tooth Regeneration: Insights from Tooth Development and Spatial-Temporal Control of Bioactive Drug Release

Tooth defect and tooth loss are common clinical diseases in stomatology. Compared with the traditional oral restoration treatment, tooth regeneration has unique advantages and is currently the focus of oral biomedical research. It is known that dozens of cytokines/growth factors and other bioactive factors are expressed in a spatial-temporal pattern during tooth development. On the other hand, the technology for spatial-temporal control of drug release has been intensively studied and well developed recently, making control release of these bioactive factors mimicking spatial-temporal pattern more feasible than ever for the purpose of tooth regeneration. This article reviews the research progress on the tooth development and discusses the future of tooth regeneration in the context of spatial-temporal release of developmental factors.

Congenital atrichia, palmoplantar hyperkeratosis, mental retardation, and early loss of teeth in four siblings: a new syndrome?

A syndrome of congenital atrichia, palmoplantar hyperkeratosis, mental retardation, and early loss of teeth was observed in four siblings (three women and one man). The pedigree is suggestive of either an autosomal recessive mode of inheritance or the inheritance of a (small) chromosomal translocation. This combination of findings has not been previously reported and is therefore considered to be a new genetic entity.

Effect of erupting third molars on dental caries and gingival health in Finnish students

The purpose of this study was to assess how the eruptive status of third molars relates to gingival and dental health and, in particular, to the status of the adjacent second molar. One hundred and twenty-three young adults were followed up over a 6-year period, from age 20 to age 26. The status of the second and third molars, and DMF, DMFS, DS, MS, and FS indices, periodontal condition, and salivary acidogenic bacterial counts were assessed. The 6-year DFS increase in relation to second molars was greatest in sextants with unerupted third molars. The percentage of erupting third molars that became carious or had been filled during the study period was 30%. Most new caries lesions or filled surfaces were on mesial surfaces of second molars and occlusal surfaces of third molars. The periodontal condition was best in mandibular sextants in which the third molar was missing. It is concluded that the most favourable situation for upper second molars is if the neighbouring third molar is missing by age 20.

An immunohistochemical analysis of human Merkel cell density in gingival epithelium from dentate and edentulous subjects

OBJECTIVE

To investigate whether there is a difference in the density of Merkel cells between the gingiva of dentate and edentate subjects.

METHODS

One hundred and two blocks of human mandibular (n=55) and maxillary (n=47) gingiva from 69 white skinned individuals (44 males, 25 females, mean age 70.1 years, range 42--92 years) were analysed. Twenty-six individuals had teeth remaining in at least one jaw (mean age of dentate 64.5 years, edentate 72.1 years), of which 15 were dentate in both jaws. Overall, 24/55 mandibles and 17/47 maxillae were dentate. Five micrometer sections were stained with a monoclonal antibody to cytokeratin 20 (CK 20) using standard immunoperoxidase or immunoalkaline phosphatase methods. Positive cells were counted in 20 consecutive high power fields using the x 40 objective in three sections from each biopsy, and the results analysed for differences related to age, sex, site and presence of teeth.

RESULTS

CK 20-positive Merkel cells were present either singly or in clusters in the basal epithelial layers, particularly at the tips of rete ridges. Numbers of gingival Merkel cells were significantly higher (p<0.005, Mann-Whitney) in edentate (cells per field mean, median, standard deviation, respectively: 1.39, 0.64, and 1.85) when compared to dentate (0.67, 0.20, and 1.21) specimens. The differences were not statistically significant for any other variable.

CONCLUSION

The data raise the possibility that reduced perception following loss of teeth may be compensated for by an increase in the local Merkel cell population.

Manifestations of insulin-dependent diabetes mellitus in the periodontium of young Brazilian patients. A 10-year follow-up study

Eight female and 3 male patients from a group of 30 patients studied 10 years earlier and who had received no periodontal treatment during this period, in order to evaluate the progression of untreated periodontal disease in patients with insulin-dependent diabetes mellitus, were evaluated in terms of plaque accumulation, gingival inflammation, probing depth, and alveolar bone loss. The total number of dental surfaces that presented clinically detectable plaque deposits increased significantly (29% to 43%; P < 0.01; chi 2 = 46.36). Site-specific comparisons for plaque index between studies showed a significant variation (P < 0.01) in the upper arch only for palatal surfaces and in the lower arch for the buccal and lingual surfaces. The total dental surfaces with inflamed surrounding gingiva increased from 11% to 33% in this study (P < 0.01; chi 2 = 175.78). Site-specific comparison for gingival index showed a significant variation for all upper surfaces, while such difference for the lower arch was significant only for the buccal and lingual surfaces. The arithmetic means for the probing depth for the upper buccal, upper palatal, lower buccal, and lower lingual surfaces increased significantly (P < 0.01). The arithmetic means of alveolar bone loss also increased significantly for the upper posterior and lower regions (P < 0.01) and for the upper anterior and lower anterior regions (P < 0.05). The correlation between age and probing depth was significant only for the upper palatal region (P < 0.01). The correlation between age and bone loss was significant only for the upper posterior region (P < 0.05). The results of this follow-up study suggest that despite little variation in plaque accumulation, gingival inflammation, probing depth, and bone loss increased after a 10-year interval in patients who had received no periodontal treatment during this period.