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Major clinical findings from a dental survey of elderly people in three different English communities.

A random sample of 2280 subjects aged 60 years or over from three areas of England were examined clinically in order to assess their dental health and needs. Between 33% (south of England) and 57% (north of England) were edentulous. Twenty per cent of all dentate subjects were edentulous in one arch and thus still required a complete denture. Amongst the dentate subjects geographical differences were small, but social class and behavioural differences were large. Dental non-attenders were the group who stood out as having much poorer oral health, averaging six fewer natural teeth than attenders. Nearly 50% of all teeth either had coronal fillings or needed them. Root caries was common, 20-22% of vulnerable teeth were affected and there was an age related increase in disease risk. The mean number of teeth with decayed roots per subject (0.8) was similar to the mean number with decayed coronal surfaces (0.9). Moderate tooth wear and moderate periodontal disease were both widespread. A minority of subjects had a functional dentition of 21 or more teeth. Major changes in the dental status of older adults have taken place in the last 30 years and these will continue, resulting in lower levels of edentulousness but a large need for maintenance of existing restorations.

Age Factors↗

The prevalence of non-carious cervical lesions in permanent dentition.

A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.

Adolescent↗

The implication of phenylketonuria on oral health.

PURPOSE: This study was performed to evaluate the oral health of children with PKU and to assess, in vitro, the erosive potential of 5 amino acid supplements commonly prescribed in the management of these children. METHODS: Forty children with phenylketonuria underwent a full dental examination and were compared with an age and sex matched control group. The erosive potential of the supplements was assessed by comparing their pH and titratable acidity to those of Coca Cola and orange juice. RESULTS: There was no significant difference between the affected and control groups in the level of dental caries, with over 75% of the children examined being caries free. However significantly more (33%) children with phenylketonuria exhibited signs of tooth wear compared with 24% of the controls (P < 0.05). While Coca Cola had the lowest pH (2.46), the titratable acidity of the flavoured supplements (92.86-126.8 mEq/l) was significantly higher than both their unflavored counterparts (4.18-14.0 mEq/l) and Coca Cola (38.56 mEq/l). CONCLUSIONS: Despite the potentially damaging nature of their diet, significantly less children with PKU had ever seen a dentist. Health professionals involved in the care of these patients should be aware of the implications of management and provide appropriate dental advice and referral.

Adolescent↗

The erosive potential of some herbal teas.

OBJECTIVES: Many epidemiological studies show a high prevalence of tooth wear, even in young patients. One factor that may be contributing to this problem is the consumption of herbal teas that are often considered to be 'healthy' alternatives to other beverages. The aim of this study was to screen a number of these products for their potential to cause erosion. METHODS: The erosive potential of a variety of herbal teas was assessed in the laboratory by measuring their pH, neutralisable acidity and their ability to erode enamel and these were compared to a positive control, orange juice. RESULTS: The pH of the herbal teas ranged from 3.1 to 7.1 and the neutralisable acidity ranged from 3.5 to 60.3 ml of 0.1M NaOH. The amount of enamel removed following 1h immersion in the herbal teas ranged from 0.00 to 9.6 microm. In comparison, the orange juice control had a pH of 3.7 a neutralisable acidity of 21.4 ml and removed 3.3 microm of enamel. CONCLUSIONS: Many of the herbal teas tested were found to be more erosive than orange juice. This information will be of use to clinicians when counseling patients with tooth surface loss.

Acids↗

Oral motor parafunctions among heavy drug addicts and their effects on signs and symptoms of temporomandibular disorders.

AIMS: To investigate the prevalence of temporomandibular disorders (TMD), bruxism, and other oral habits among drug addicts compared to a normal, non-addicted, matched control population, and to assess the detrimental effect of long-term drug abuse on the parameters studied. METHODS: Subjects included 55 drug-addicted patients (51 males and 4 females) randomly selected from long-term addicts using "hard" narcotics and attending a methadone maintenance center and a control group of 52 normal non-addicted individuals (48 males and 4 females) matched to the addicts for age, gender, and socioeconomic status. A clinical examination and a questionnaire were used. One examiner determined that all questions were correctly understood and answered, and a second examiner performed the clinical examinations and was unaware of the results of the questionnaire. RESULTS: The addicted group had a high prevalence of orofacial motor behavior (bruxing, clenching) as well as signs and symptoms of TMD (morning headache, joint noises, joint and masticatory muscle tenderness to palpation, and tooth wear) compared to the controls. Active (voluntary) jaw opening was significantly smaller, although within an acceptable range when compared to the controls. CONCLUSION: Long-term drug abuse detrimentally affects the stomatognathic system, as expressed in a high prevalence of oral motor behavior and signs and symptoms of TMD.

Adolescent↗

Dual bite demonstrated by kinesiography: a case report.

A 60-year-old man sought treatment for extensive tooth wear resulting from bruxism. He had no signs of temporomandibular joint dysfunction. The kinesiographic study revealed that he had a dual bite, with two intercuspal positions, separated by 3 mm anteroposteriorly and by 7 mm laterally. The dentition was restored with metal-ceramic crowns to restore a normal occlusion. The kinesiographic follow-up studies revealed that, initially, it was difficult for the patient to adapt to a new occlusal design, but 6 years later, the dual bite had disappeared. However, the disoccluding angle had flattened where the second intercuspal position had previously existed, corresponding, clinically, to a change from canine guidance to anterior-canine guidance.

Bruxism↗

[Occupational differentiation in dentistry 2. From Brueghel's syndrome to a radiant smile. An advanced postgraduate programme in oral kinesiology].

Oral movement disorders, jaw pain, and tooth wear are examples of clinical problems that are part of the dental discipline 'oral kinesiology'. About half of the advanced postgraduate programme in oral kinesiology involves the diagnosis, indication, and management of patients with one or more oral kinesiologic problems. The remaining time is available for thematic courses and a research project. The breadth of the programme will hopefully lead to improved care for patients whose treatment until now has been dispersed between various dental specialists. Successful candidates will obtain an advanced postgraduate diploma in Oral Kinesiology, and can also apply to be recognized as a gnathologist.

Bruxism↗

Risk assessment and preventive measures.

A prerequisite for preventive measures is to diagnose erosive tooth wear and to evaluate the different etiological factors in order to identify persons at risk. No diagnostic device is available for the assessment of erosive defects. Thus, they can only be detected clinically. Consequently, erosion not diagnosed in the early stage may render timely preventive measures difficult. In order to assess the risk factors, patient should record their dietary intake for a distinct period of time. Then a dentist can determine the erosive potential of the diet. Particularly, patients with more than four dietary acid intakes have a higher risk for erosion when other risk factors (such as holding the drink in the mouth) are present. Regurgitation of gastric acids (reflux, vomiting, alcohol abuse, etc.) is a further important risk factor for the development of erosion which has to be taken into account. Based on these analyses, an individually tailored preventive program may be suggested to the patients. It may comprise dietary advice, optimization of fluoride regimes, stimulation of salivary flow rate, use of buffering medicaments and particular motivation for nondestructive toothbrushing habits with a low abrasive toothpaste. The frequent use of fluoride gel and fluoride solution in addition to fluoride toothpaste offers the opportunity to reduce somewhat abrasion of tooth substance. It is also advisable to avoid abrasive tooth cleaning and whitening products, since they may remove the pellicle and may render teeth more susceptible to erosion. Since erosion, attrition and abrasion often occur simultaneously all causative components must be taken into consideration when planning preventive strategies.

Acids↗

Coronal and apical lesions, environmental factors: study in a modern and an archeological population.

Apical periodontitis (AP) are frequent findings in contemporary dental practice in association with dental pathology or dental care. They have also been studied from an anthropological background. The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population, and to evaluate the influence of environmental factors. Both the archaeological sample group and dental practice subjects were from southern France. The study included full mouth surveys of 252 individuals (2,780 teeth) from a historic necropolis and 223 subjects (5,678 teeth) randomly selected from the Gard area. Tooth wear, caries, and AP were accounted for clinically and radiographically according to specific indexes. Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP. Antemortem teeth loss and dental wear had been reduced, whereas caries rates and AP had increased between archaeological and modern population. The AP ratio was associated with the level of dental care in the modern population. Although significant variations could be observed between archaeological periods, the rupture in E3 (sixteenth and seventeenth centuries) leads to consider the associated population as a premodern. However, it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population, dental care seemed to have a strong influence on AP ratio in modern ones.

Adolescent↗

Is there a need for gerodontology?

One of the major criteria of successful ageing is maintaining a natural, healthy, functional dentition throughout life, including all the social and biological benefits such as aesthetics and comfort, and the ability to chew, taste and speak. However, the oral health of elderly people is far from optimal. The treatment needs are high due to edentulism, missing teeth, caries, periodontal diseases and tooth wear resulting in impaired oral functions. The demand for treatment is much lower than the need. In the future the elderly will retain their natural dentition and more teeth per individual will be present. Despite this there will be a rise in edentulousness due to the sharp rise in numbers of the elderly population. The 'new elderly' will be more critical and more demanding of oral health care services. The dental profession and governments in all industrialised countries must be aware of these trends which should be reflected in undergraduate and postgraduate education of dentists and in research. The European College of Gerodontology has been founded to contribute to solving all problems related to oral health and oral health care of the elderly.

Aged↗

[Evaluation of relation between signs of trauma from occlusion and severity of periodontitis].

The aim of the present study was to evaluate the various occlusal interferences, signs of trauma from occlusion and their relations to severity of periodontitis. 32 cases of moderate to advanced adult periodontitis patients participated in the study with a mean age of 37.6 years. All subjects received a complete periodontal examination and occlusal analysis. The results indicated that teeth with various occlusal interferences did not exhibit any greater severity of periodontitis than those without interferences. However, widened periodontal ligament space (PDLS) was frequently seen in teeth with occlusal interference. Two combined criteria were initially suggested to identify the occlusal trauma in clinic. The first criterion included presence of functional tooth mobility plus radiographically widened PDLS. The second, presence of significant tooth wear plus radiographically thickened lamina dura. The results showed that teeth with the first criteria had deeper probing depth, more clinical attachment loss and less alveolar bone support than teeth without these findings. However, teeth with the second criteria had less attachment loss and more bone support than teeth from control group. It was suggested that both of the combined criteria provide better reliability in determination of established occlusal trauma as well as evaluation of adaptive capacity of periodontal structure to increased biting force. The regression analysis demonstrated that given equal clinical attachment levels and similar inflammation, teeth with evidences of functional mobility and widened PDLS had less osseous support than teeth without these findings (P < 0.01). The difference became greater in line with the more loss of clinical attachment.

Adult↗

Oral health in alcohol misusers.

One hundred and seven chronic alcohol misusers (mean age 42.9 years; range 21-65 years; 80 males) attending four centres in South East London were interviewed on their current and past alcohol consumption. Their nutritional status (body mass index (BMI) and mid arm muscle circumference) was also recorded. Each subject completed a dental and oral mucosal examination. Ninety four per cent of the sample consumed greater than 50 units of alcohol per week and 80 per cent greater than 100 units of alcohol per week. Smoking and alcohol misuse were found to be related, 81 per cent reporting both habits. Neither plaque index scores or mean subject pocket depths were correlated with alcohol consumption but both were positively correlated with the frequency and duration of smoking. Overall mean DMFT was 15.4; age specific mean DMFT and tooth loss of the sample were closely similar to the 1988 United Kingdom adult dental health survey data. The prevalence and severity of tooth wear and attrition were greater in the sample than levels described in the literature and these dental features may prove useful markers to the practitioner. Trauma to teeth and oral mucosae was noted in 25 per cent of the sample. Seven oral mucosal lesions (including one treated carcinoma) were detected; mucosal trauma could have acted as a co-factor. Furthermore, 21 per cent of the alcoholics were malnourished (BMI < 20). It is concluded that, unlike several reports from the United States, dental health in this sample of alcoholics is not compromised; however mucosal health is a cause for concern.

Adult↗

The role of cosmetic dentistry in restoring a youthful appearance.

BACKGROUND: Dentistry is faced with a population that is getting older and keeping more of its natural teeth. Smiles show physical and esthetic signs of aging. Advances in the area of cosmetic dentistry now offer the dental profession new opportunities in conservative and esthetic restorative procedures that have the potential to reverse the signs of dental aging, thereby making patients appear younger. CASE DESCRIPTION: The physical and esthetic attributes of an aged dentition are identifiable. Tooth wear over time alters the appearance of the teeth and smile in a way that is perceptible to dentists and laypeople. Bonding and adhesive ceramic restorative procedures have the potential of reversing the esthetic manifestations of the aging process for teeth. Specific diagnostic tools, including a composite resin mock-up and construction of an incisal putty matrix, allow for previsualization of possible treatment outcomes and allow clinicians to resolve occlusal as well as esthetic treatment concerns before initiating actual treatment. CLINICAL IMPLICATIONS: The ability to make patients look younger through cosmetic enhancement of teeth and smiles has tremendous implications for the future practice of dentistry. Dentists who have the training and skills to meet the increasing demand for esthetic procedures by patients seeking to restore a youthful appearance may find an expanded role within their practices for this type of treatment.

Dental Veneers↗

Vegetarian children and dental erosion.

BACKGROUND: There have been recent changes in teenage lifestyle and diet. The increasing consumption of soft drinks and foods containing significant acidic components may play a role in the development of dental erosion. OBJECTIVE: The aims of this investigation were firstly to assess the prevalence of vegetarian children in a cluster random sample of 14-year-old children in Birmingham, United Kingdom. Secondly, to determine the prevalence of dental erosion in these children, and thirdly, to see if there were any differences between vegetarian and non-vegetarian children in the prevalence of dental erosion and dietary intake. DESIGN: A cluster random sample of 418 14-year-old children (209 males and 209 females) were examined from 12 different schools in Birmingham, United Kingdom; a dietary questionnaire was completed and the levels of tooth wear were recorded using a modification of the (TWI) index. All data were analysed using SPSS with t-test and Chi-square analysis. Significance was accepted at the P < 0.05 level. RESULTS: The results showed that 10% of the children were vegetarian; 52% of them had low dental erosion and 48% moderate dental erosion. Statistically there were no significant differences between vegetarian and non-vegetarian children in the prevalence of erosion; however, there were significant differences in some food and drink consumption. CONCLUSIONS: It was concluded that dental erosion is common in teenage children, but there were no significant differences in prevalence between vegetarian and non-vegetarian children.

Adolescent↗

The British Nutrition Foundation Oral Task Force report--issues relevant to dental health professionals.

A recent report on diet and oral health by the British Nutrition Foundation reviews the anatomy, microbiology and pathology of a number of oral diseases including dental caries, tooth-wear, oral cancer, periodontal disease and enamel defects. The role of nutritional factors in the aetiology and prevention of these oral diseases is discussed. The report states that improvements in the levels of caries in the UK are halting and remain unacceptably high in some 'at risk groups'--including the socially deprived. It states that a two-pronged attack, i.e. reduced frequency of consumption of sugary foods and use of fluoride is necessary to address the problem. To address the increased prevalence of oral cancer avoiding tobacco, limiting alcohol and increasing fruit and vegetable consumption are recommended. Recommendations for approaches to improve oral health are made for health authorities, industry, schools and health professionals and it is recommended that the Government make adequate resources available to improve oral health preventive strategies.

Aged↗

Gingivitis around the deciduous teeth of sheep.

Two-hundred and eight sheep from two farms were killed mostly in age-matched groups of 6 between the ages of 6 and 141 weeks. Sheep from one farm (W) had excessive tooth wear whilst sheep from the other (G) had little. The four deciduous incisor teeth and the third premolar from one side of the mandible of each sheep were examined by light microscopy. The inflammatory reaction in the gingiva around the sulcus and sulcular epithelial proliferation were subjectively assessed. Sheep from both farms initially showed a neutrophilic reaction. From approximately 25 to 100 weeks of age, sheep from farm G had a more extensive reaction than those from farm W involving neutrophils and mononuclear cells. The latter showed a more frequent tendency to spread on farm G than on farm W. The length of the sulcus was also more often greater on farm G. In contrast, the proliferation of the sulcular epithelium in both width and length was not greater on farm G. It is suggested that the severity of the gingivitis was arrested at a less severe stage on farm W than on farm G and that the pathogenesis of sulcular epithelial proliferation may different from that of gingival inflammation.

Animals↗

Dental microwear texture analysis shows within-species diet variability in fossil hominins.

Reconstructing the diets of extinct hominins is essential to understanding the paleobiology and evolutionary history of our lineage. Dental microwear, the study of microscopic tooth-wear resulting from use, provides direct evidence of what an individual ate in the past. Unfortunately, established methods of studying microwear are plagued with low repeatability and high observer error. Here we apply an objective, repeatable approach for studying three-dimensional microwear surface texture to extinct South African hominins. Scanning confocal microscopy together with scale-sensitive fractal analysis are used to characterize the complexity and anisotropy of microwear. Results for living primates show that this approach can distinguish among diets characterized by different fracture properties. When applied to hominins, microwear texture analysis indicates that Australopithecus africanus microwear is more anisotropic, but also more variable in anisotropy than Paranthropus robustus. This latter species has more complex microwear textures, but is also more variable in complexity than A. africanus. This suggests that A. africanus ate more tough foods and P. robustus consumed more hard and brittle items, but that both had variable and overlapping diets.

Animals↗

Quantification of dental microwear by tandem scanning confocal microscopy and scale-sensitive fractal analyses.

Dental microwear analysis is among the most commonly used approaches to reconstructing the diets of extinct animal species and past peoples. The usual procedure involves imaging tooth wear surfaces by scanning electron microscopy (SEM). Surfaces are characterized quantitatively by measurement of individual wear features (pits and scratches) on photomicrographs. Recent studies of living animals have shown associations between diets on one hand and patterns of dental microwear on the other. Furthermore, patterns on fossil teeth have been used to reconstruct diets in extinct forms. However, conventional methods for microwear analysis are limited. Scanning electron microscopy does not provide a true representation of these surfaces in three dimensions, and identification and measurement of individual features is time consuming, subjective, and subject to high interobserver error. This paper describes a new approach to the analysis of dental microwear using tandem scanning confocal microscopy and scale-sensitive fractal analyses. The instrument used in this study provides three-dimensional coordinates representing surfaces at a resolution equivalent to that employed by most SEM microwear studies. Fractal analyses offer objective, repeatable, quantitative characterization of surfaces. This approach eliminates major sources of error and increases power to resolve differences between species. Moreover, rapid surface characterization will allow examination of large samples to assess within species variation and to make finer distinctions between species.

Animals↗