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PubMed2004

Influence of tobacco smoking on periodontal bone height. Long-term observations and a hypothesis.

AIM: The aim of the investigation was to estimate the magnitude of the long-term influence of chronic smoking on the periodontal bone height. METHODS: The study population included 19 continuous smokers, 28 former smokers and 44 non-smokers in the age range 20-60 years at baseline. The participants were examined at two points in time with an interval of 10 years. The height of the periodontal bone was determined from bite-wing radiographs of the first and second premolars of the maxilla and the mandible and measured from the cemento-enamel junction (CEJ) to the periodontal bone crest (PBC) mesially and distally to the preselected teeth. RESULTS: The mean (SD) CEJ-PBC distance at baseline was 1.82 (1.01) mm for smokers, 1.65 (0.81) mm for former smokers, and 1.16 (0.59) mm for non-smokers (p=0.016). The mean (SD) 10-year bone height reduction was 0.74 (0.59) mm for smokers as against 0.26 (0.31) mm for former smokers and 0.27 (0.29) mm for non-smokers. Controlling for age and baseline bone height level, the magnitude of the reduction was significantly dependent of smoking (p=0.000). The widening gap between smokers and non-smokers over time suggested that the bone height reduction of smokers took place at an accelerated rate. CONCLUSION: On the basis of the observations it is hypothesized that smoking induces an acceleration of the periodontal bone height reduction rate and that smoking cessation results in a return towards non-smoker rate.

Adult↗
PubMed2005

The effect of quitting smoking on chronic periodontitis.

OBJECTIVES: To evaluate longitudinally the effect of smoking cessation on clinical and radiographic outcomes following non-surgical treatment in smokers with chronic periodontitis. MATERIAL AND METHODS: Forty-nine smokers with chronic periodontitis who wished to quit smoking were recruited. Full-mouth probing depths, bleeding and plaque data were recorded at baseline, 3, 6 and 12 months. Clinical attachment levels were recorded at target sites and subtraction radiography was used to assess bone density changes. Patients received non-surgical periodontal therapy during the first 3 months and supportive periodontal care over the remainder of the study. Smoking cessation counselling was provided according to individual need. RESULTS: After 12 months, of patients with complete data, 10 had continuously quit smoking (20% of the original population), 10 continued smoking and six were oscillators (those patients who quit and then relapsed). There were no differences between the groups following treatment with respect to mean clinical or radiographic parameters. Analysis of probing depth reductions between baseline and month 12, however, and comparing quitters with the other two groups combined, demonstrated a significant difference in favour of quitters (p<0.05). Furthermore, quitters were significantly more likely to demonstrate probing depth reductions > or =2 and > or =3 mm than non-quitters and oscillators (p<0.05). CONCLUSION: Quitting smoking has an additional beneficial effect in reducing probing depths following non-surgical treatment over a 12-month period.

Adult↗
PubMed1991

Evaluation of a radiographic partial recording system assessing the extent and severity of periodontal destruction.

The purpose of the present study was to evaluate the validity and reliability of a partial radiographic bivariate index system (PESI-2). The principles of the index were applied to data from a random sample of 192 industrial employees aged 30-65 yr. Estimates of Extent and Severity of radiographic bone loss provided by the PESI-2, as well as adjusted estimates by means of simple regression models, were compared to values obtained by a full mouth radiographic examination. It was shown that the values provided by the PESI-2 were of rather high validity and reliability. The use of the adjusting models resulted in increased validity of the severity estimates and enhanced reliability of both components of the bivariate. The results verified the applicability of the PESI-2 in epidemiologic research of destructive periodontal disease.

Adult↗
PubMed1992

Predicting development of approximal dentin lesions by means of past caries experience.

The aim of this study was to assess the accuracy in predicting future development of approximal dentin lesions using radiographically observed numbers of restored and carious surfaces at age 13 as diagnostic criteria. ROC curve technique was applied employing the development of at least one new dentin lesion from age 13 to age 15 and 18 respectively, as validating criterion. Two groups of patients were considered, residing in communities with water fluoride content of 0.2 ppm and 1.2 ppm, respectively. Results showed that the development of dentin lesions could be predicted with an accuracy similar to that of many other dental radiographic procedures. This implies that it ought to be possible to use previous caries experience as a means of individualizing the scheduling of future radiographic procedures.

Adolescent↗
PubMed1992

Caries prevalence in primary teeth as a predictor of early fissure caries in permanent first molars.

The study aimed to examine the validity of employing the caries experience of the primary dentition for predicting early caries in the permanent first molar fissures. Subjects consisted of 192 children who were followed for 2 yr, 91 of whom were pursued for a further year, all receiving semiannual check-ups. The caries prevalence in the primary dentition (dmft), excluding incisors, was recorded at baseline, which was the year the children became 6. Fissure caries in the permanent first molars was recorded as being confined to enamel or dentin, based on findings during cavity preparation. The correlation between dmft and the number of intact permanent first molars was -0.368 and -0.337 after 2 and 3 yr observation respectively. When the children were grouped according to their dmft, a statistically significant relationship was found between the dmft and the number of intact molars in each individual. The positive and negative predictive values as well as the sensitivity and specificity of different dmft values were calculated, and the relationship between them illustrated by the use of ROC curves. Even if there are no specific dmft values which seem obviously favorable for the purpose, these data give information relevant in planning for large scale use of fissure sealing in preventing early fissure caries in permanent first molars.

Child↗
PubMed1993

A radiographic study of dental health in adult patients with dental anxiety.

The objective of this study was to compare the dental health in a group of 90 patients with severe dental fear (FP), aged 20-41, with that of a matched control group of ordinary dental patients (OP). All registrations were made from radiographic intraoral full mouth surveys. Mean number of missing teeth among FP and OP patients was 4.4 and 2.5, respectively. On average, FP patients had 19.5 decayed surfaces compared to 7.9 in OP patients. Mean number of filled surfaces was 13.1 and 8.1 in OP and FP patients, respectively. FP patients, on average, had significantly more periradicular bone lesions as well as pronounced marginal bone loss than OP patients. This study showed that dental fear patients in general have a substantially deteriorated dental health compared to ordinary dental patients. Moreover, different dental care habits were evident between FP and OP patients. A progressive severity in dental disease pattern was found among FP patients.

Adult↗
PubMed1994

Dental behavior management problems in Swedish children.

4505 Swedish children aged 4-11 yr were surveyed regarding dental behavior management problems (BMP) and dental health. Dental charts were retrieved from clinics in the Public Dental Service in Göteborg, and data were then compiled regarding BMP, action against BMP, caries, fillings, use of local anesthetics, and number of missed appointments. Behavior management problems were found in 10.5% of the children, and were more common in the younger children, among children who missed appointments, and in children who received restorative treatment without local anesthetics. The BMP children had more carious and fewer filled surfaces. In 43.4% of the cases with BMP the strategy chosen was postponement of dental treatment or no measure taken.

Age Factors↗
PubMed1995

Radiographic study of approximal restorative treatment in children and adolescents in two Swedish communities differing in caries prevalence.

In two groups of patients, differing in caries prevalence, the restorative treatment of posterior approximal surfaces in permanent teeth was studied in radiographs obtained as part of the dental care provided from age 6 up to and including age 18. The study determined at what age, at which lesion depth and in which surfaces restorative treatment was performed. Furthermore, the conditions of nonrestored dentin lesions were evaluated over time. Nearly 50% of the restorations were placed in the mesial surface of the first molars. In both groups more than 2/3 of the restorations were placed in surfaces with dentin lesions. In the group with the highest caries prevalence 50% of the lesions in the outer half of the dentin were restored when first detected in contrast to 20% in the groups with the lower prevalence. For the superficial dentin lesions not immediately restored, average time between their detection and restoration, the end of the study or, detection in the inner half of the dentin was practically the same in both groups (19.3 and 20.4 months). The variation in this average time was only to a limited degree explained by the variation in the caries experience of the patients.

Adolescent↗
PubMed1996

Relationships between free smooth surface and proximal caries in the young permanent dentition.

Cross-sectional relationships between free smooth surface and proximal caries were assessed in 3 age groups, comprising 252 subjects aged 12 yr, 301 aged 15-16 yr and 102 aged 18-19 yr. Caries diagnosis was clinically on white spot and radiographically on enamel lesion level. Fair correlation between buccal-lingual and proximal caries observed among 12-yr-olds (r=0.47) declined in the older subjects (r=0.24). While statistically significant the variability in proximal caries, explained by buccal-lingual lesions, was low (range 6-22%). Sensitivity and specificity for buccal-lingual lesions as an indicator for proximal caries in the same tooth ranged from 0.37-0.44 and 0.84-0.91, respectively, with associated Pv+ and Pv- ranging from 0.41-0.44 and 0.84-0.91, respectively. Sensitivity and specificity for buccal-lingual caries in identifying subjects with proximal caries ranged from 0.33-0.44 and 0.67-0.98, respectively. Pv+ ranged from 0.94-0.99 and Pv- from 0.06-0.35. ROC curve analysis yielded A(z)-values of about 0.76 in the two younger age groups and 0.57 in the oldest. The results imply that information obtained from visual examination should be applied with caution when inferences about current caries status on proximal surfaces are made from the presence of buccal-lingual caries.

Adolescent↗
PubMed1996

Number of mutans streptococci or lactobacilli in a total dental plaque sample does not explain the variation in caries better than the numbers in stimulated whole saliva.

For practical reasons the numbers of mutans streptococci (MS) and lactobacilli (LB) in plaque are commonly estimated from saliva samples. The saliva counts are considered to be a reasonable indicator of the entire dentition's total microbial load. However, the value of salivary counts for explaining and predicting caries have been found to be low. There was therefore reason to compare the relationships between caries on the one hand and, on the other, the number of MS or LB in plaque and in saliva, respectively, in order to assess their relative merits for explaining the variation in caries, both in a total material and in subgroups with less favourable oral hygiene. Sixty children aged 14-15 years participated in the study. Caries and plaque were registered and the number of MS and LB was estimated in total plaque and in stimulated saliva samples. The results showed that the number of MS or LB in plaque did not explain the variation in caries to a greater degree than did the salivary counts. For both bacteria the explanatory values increased, as expected, in subgroups with less favourable oral hygiene, but not even at this higher level of explanation was there any difference between plaque and saliva. The LB count was a stronger explanatory variable than the MS count. It was concluded that the number of MS and LB, estimated in total plaque as well as in saliva samples, is not a useful tool in prediction.

Adolescent↗
PubMed1996

Variations in restorative treatment decisions: an international comparison.

Variations between dentists in treatment thresholds and diagnostic decisions based on radiographs have not been fully explained. Since variations have been shown to exist between as well as within countries, it is possible that the structure of incentives inherent in different health care systems, and cultural influences on health and health care may play a part. This paper compares the results of a study undertaken in Scotland with a replication study undertaken in Canada concerning dentists' restorative thresholds and treatment decisions based on radiographic evidence. The Canadian dentists operated with greater sensitivity but lower specificity than their Scottish counterparts, although ROC analysis indicated similar overall abilities to detect carious lesions. The dentists' action thresholds also differed. However, methodological issues mean that the data from the study need to be interpreted with caution.

Adolescent↗
PubMed2005

Caries risk assessment: methods available to clinicians for caries detection.

It is hypothesized that occlusal lesions are initiated on the fissure walls and can therefore be obscured by sound superficial tissue. Additionally, there is evidence that one effect of regular use of fluorides is greater opacity of enamel, which may obscure underlying lesions in dentin, the so-called 'hidden lesions'. Dental radiographs are inadequate for detecting decay in the occlusal surfaces until the lesion is well advanced through the enamel and into the dentin. The clinician relies on visual observation of texture and discoloration, clinical judgment based upon experience, and on tactile sense by probing with an explorer. An objective detection method to complement the traditional visual assessment is used by the clinician for arriving at clinical decisions on the management of the carious lesion: whether invasive therapy or a more conservative, noninvasive approach. Objective and reliable longitudinal monitoring of the lesion's response to preventive measures allow the selection of an appropriate therapy before the lesion progresses to the stage where invasive treatment is required. This paper discusses the problem of the lack of appropriate clinical methods for the detection and quantification of carious lesions. A few commercially available methods are described (the quantitative light-induced fluorescence method, the DIAGNOdent device, and electrical caries monitor) and some new techniques mentioned.

Dental Caries↗
PubMed2006

A field trial of resin-based and glass-ionomer fissure sealants: clinical and radiographic assessment of caries.

OBJECTIVE: The purpose of the present study was to provide further data for comparison of retention and caries-preventive effect of a resin-based sealant (Delton, and a glass-ionomer sealant (Fuji III). METHODS: The study was conducted in the municipality of Vaerløse located 15 km north of Copenhagen, Denmark in the period 1996-2001. The study comprised 153 children aged 8-13 years with a total of 364 site-pairs. Caries was diagnosed both clinically and radiographically, and sealant retention was diagnosed clinically. Sealants were placed either by one of four dentists, who had the responsibility for the children's dental care, by a dental hygienist or a dental assistant. Mean follow-up time was 38-39 months for sites on first permanent molars and 28-29 months for sites on second permanent molars. RESULTS: The retention rates were consistently, and considerably lower for Fuji III than for Delton. Relative risks of caries in Delton-sealed teeth over Fuji III-sealed teeth was 0.435 (95% CI 0.150-0.846) based on the clinical diagnosis, and 0.559 (95% CI 0.342-0.905) based on the radiographic diagnosis. The ratio of the relative risks (clinical over radiographic diagnosis) was close to 1 (0.778; 95% CI 0.272-1.481). CONCLUSION: In the present study, Delton-sealed teeth had a lower risk than Fuji III-sealed teeth of developing caries, independent of the caries diagnostic method used.

Adolescent↗
PubMed1992

Progression of approximal caries in primary molars and the effect of Duraphat treatment.

The progression of caries lesions over a 2-yr period was studied in 3-6-yr-olds. All 468 children included in the study lived in an area during 1977-85 (Malmö, Sweden) with a low fluoride concentration (0.2 ppm) in the drinking water. Radiographs were taken with a standardized periodic identical technique. Caries lesions were scored on the distal surface of the first and on the mesial surface of the second primary molars (maximum 8 per child) according to Gröndahl et al. Half of the children were treated semiannually with a fluoride varnish (Duraphat). In all, 421 surfaces with caries at baseline were available at the 1-yr examination and 369 at the 2-yr examination. After 1 yr, 34.1% of the shallow enamel lesions remained unchanged, while a progression was seen in 60.9%. 5.1% had been restored. The corresponding figures after 2 yr were 20.6, 52.1 and 27.3%. Of the deeper enamel lesions at baseline, 28.8% remained unchanged after 1 yr and 13.7% after 2 yr. Of the lesions extending into the dentin, 81.5% had been restored after 1 yr and all after 2 yr. When evaluating the effect of Duraphat, only the percentage of individuals with one or more superficial enamel lesions showing progression was determined. After 1 yr, 51.2% in the Duraphat (n = 41) and 82.8% in the control group (n = 29) showed progression (restored surfaces included). The corresponding figures after 2 yr were 66.7 (n = 42) and 91.2% (n = 34). The differences after both 1 yr and 2 yr were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1996

Plaque fluoride and mutans streptococci in plaque and saliva before and after discontinuation of water fluoridation.

Our aim was to compare plaque fluoride and the level of mutans streptococci in saliva and plaque before and 1 and 2 years after discontinuation of water fluoridation in Kuopio, Finland. For comparison, a low-fluoride community was included in the study. Pooled plaque and saliva were collected from a random sample of 12-year-olds in both communities (n = 139). Enumeration of mutans streptococci in plaque was made on MSB agar and the level of salivary mutans streptococci was measured using the Strip mutans method. Fluoride was analyzed using a fluoride specific electrode. Caries, gingival status, fluoride varnish applications and self-reported oral health habits were recorded at baseline. Before discontinuation of fluoridation, the level of mutans streptococci in saliva was significantly lower in the fluoridated than in the non-fluoridated community. The difference in plaque mutans streptococci was not statistically significant. After discontinuation of water fluoridation, there was a significant shift towards elevated values of salivary mutans streptococci in the fluoridated community, but the level of mutans streptococci in plaque remained at the baseline level. There was no significant difference between the communities in the fluoride content of plaque either before or after discontinuation of fluoridation. From the background factors, only caries scores (higher in the non-fluoridated community) and oral hygiene (better in the non-fluoridated community) were significantly different between the communities.

Chewing Gum↗
PubMed1996

A 3-year clinical study of tunnel restorations.

Tunnel restorations (n = 161) performed by 4 dentists were evaluated after a mean of 35 months in situ. Demineralized enamel was to be spared during preparation. The preparations were filled with a cermet glass ionomer (polyalkenoate) cement. Evaluation was carried out using clinical and radiographical criteria. During the observation period, approximately 16% of the restorations were replaced due to caries in dentin and 14% due to marginal ridge fracture. Cavitation in the approximal surface and/or increased radiolucency of the approximal enamel were observed in 34% of the remaining tunnel-restored teeth. A significantly higher frequency of failures were registered when treating patients with a high caries activity, where the initial lesion was large, and where the restoration did not reach the approximal surface.

Adolescent↗